A 


MANUAL  OF  DIETETICS 


r,v 


J.  MIEXER  FOTIIERGIEL,  M.IX  EDIX 


\F.\Y  YORK 
WILLIAM    \V(  )(  )1)    ^-    e'OMTAXV 


CONTEXTS. 


PAIIT    I. 
CHAP.         I. — FOOD:   Its  Ohjret. 

II.  —  Forms  of  Food  and  their  Digestion. 
III.  — Methods  of  1'reparin-  Food. 
IV. — Condiments,  .... 

V.  —  l>everaires,          .... 
VI.— Stimulants,  .... 

VII.  — Fluid  Foods 

VIII.  —  1'ivsrrvt'd  and  Canned  Funds. 
IX. —  Prepared   Foods, 
A. — Artitieial  |);^esii\e  Agents.     . 


I'A'iK 
1 


4!) 
ti4 


PART    II. 

XI.  —  F>">d  in  Int'anev, 

XII. --Food  in  Ad,,, I,.,, TII, v.  . 

X  1 1  I.  —  F 1  in   Adult    I-ii'e.    . 

XIV.  —  F 1  in  Old  A-e, 

X  V.  —  I-'nod  in  .\<-iite  I  Disease. 

X  \'I.—  Fund  in  (  '(imalesreliee, 

X\'I1.     -Food  in  Castrie  Ail'eetions, 

XVIII.      F,-.d  in  Strunia 

XIX.      F,  Mid  in  An:eniia. 

XX.      Food  in  Constipation  and   hiai 

XXI.— Food  in  Phthisis, 

XXII.  — Food  in  Chronic  Heart  and   [. 


\  ill 


CUXTKNTS. 


Cn  vl'.    XX  I  II.       I-' 1  in  I'.ri-ht^  I>is.>as<>. 

\  X  1  \  .  l-'i » 'il  in  AHuiiiiinuria. 

X.\V.      I' 1  in  i>iuU'U's 

X  X  V  I.  !•'"•  "i  in  ( ;  Ivmsuria.     .... 

XX\  II.-    I-' 1  in  (iuiit 

XX  \  III.-    !• i  in  N.'iirusa]  AiTivtiniis.       . 

XXIX.  I-'-,,!  IMP  t'l. runic  Invalids,      . 

XXX.      !•' !  in  Oboitv 

XXXI.      !• 1  in  Indigestion 

XXX  II.      I- i  in  P.iliuusnrss 

X  X  X  i  1  i.  I-'. ...I I  -i\.-M  i.lliLT\visr  than  l>y  the  Month. 

I'l'lU-ili-.'  HI. 


I'Af.K 

.    IS!) 


•Co 

FORDVCK    HARKKR,    M.I).,    LT..D.,    KDIX., 

AN    ACKNi  >\VI.KlH;i:n    I.KAUKR    IN    Ml.DK  i\l, 
THIS    WORK 

IS     AFFECTION  AT  Kl.V     DEDICATED 

I'.V 
THE    AUTHOR. 


PREFACE. 

The  day  of  Dietetics  lias  arrived. 

Modern  advances  in  our  knowledge  of  the  physiology  of 
digestion  have  been  accompanied  by  a  like  progress  in  the 
preparation  of  foods.  The  value  of  predigested  carbo- 
hydrates in  acute  disease  and  nialassiniilation  among  adults, 
as  well  as  children,  is  now  being  gradually  realised.  'Un- 
digested albuminoids  are  making  their  way  ;  while  oil 
emulsions  have,  established  themselves  on  a  lirni  footing. 
The  many  evils  of  a  dietary  too  rich  in  albuminoids  are  now 
being  generally  recognised.  The  time  indeed  is  at  hand 
when  systematic  lectures  on  Food  will  be  a  part  of  Medical 
educat  ion  ;  while  the  value  of  feeding  in  disease  is  admitted 
to  be  as  important  as  the  administration  of  medicines. 

;;,    llKNHlKTTA    STKKKT, 

CAVENDISH  SVCARK, 

LONDON,  \V. 


MAXt'AL   OF    DIETETICS. 


TIIK   OIUKCT   OF    FOOD. 

l)i-:i-'i>UK  the  days  of  chemistry,  food  \v;is  in  its  pre-scientitic  staue. 
Then  it  was  mainly  :i  question  of  the  palate.  Kinirs  kept  their 
rooks,  ami  smaller  personages  imitated  them.  The  rooks  cooked  bv 

day  and    devised    ne\v  dishes  bv  ni^ht.       In   the    pre.-cnt   work,  how- 
ever, this  culinary  aspect,   of  food  will  he  subordinated  to  that  of  its 

sclent  llic  aspect. 

Not  that  the  cook  is  to  he  ignored,  hv  anv  means.  Without 
proper  cook  in";,  no  food  is  palatable;  and  if  the  palatt  —  the  janitor 
of  the  stomach  -he  oll'ended.  no  matter  what  is  its  real  value,  th" 
food  is  useless.  The  palate  must  he  consulted  as  well  as  the 
stomach. 

Of  old  the  palate  ran  not.  The  Romans  "were  both  epicures  and 
gluttons.  The  ovs'crs  of  llritain  were  convcvcd  hv  relavs  of  run- 
ners to  t  he  Roman  villas.  One  epicure  cast  a  slave  into  his  tishpond 
to  improve  the  flavour  of  his  lamprevs.  The  most  absurd  dishes 
were  contrived,  up  to  a  pie  of  n i^htinirales'  tonirues.  'I'hcir  tastes 

11  r"  r^ 

were  not  ours.  Fowls  \vere  boiled  in  aniseed  water,  and  served 
with  a  sauce  coin  a;  m  nil"  aniseed,  mint .  mustard  seeds  and  asat'o  t  id  a. 
Nor  were  the  middle  au'cs  far  ditVerent.  Charles  \.  of  (ier- 
manv  was  a  notorious  gourmand.  liesidcs  ordinarv  meats  he  had 
roasted  horse,  cats  in  jellv,  li/ard  soup,  fried  frog's,  etc..  till  In-  ' 
\vhen  asked  fora  new  dish,  could  onlv  surest  a  compote  of  watches, 
-in  allusion  to  that  monarch's  passion  for  such  time-keeper-. 

Animals    were    chased    because    it    wa-    found    that    the    ile.-h  o| 
liuntcd    beasts    was    nioi-c    tender    and    palatable    tliati    thai    < 
killed   without  such   preliminary  preparation.       Fo\v!<  wei'e    !:.ra-::'-d 
to  death    to    lit   them   for  t  lie  table;    while  one   writer  v;a\e  , 


1'  MANUAL    (>F    I  MKTKTK 'S. 

"  HOW  t'i  n>a-t  ninl  eat  a  irni'se  alive."  No  crm-ltv  to  an  animal  was 
l<«>  Lrrcat  1"  uTatifv  tlic  palate.  It  wa-  merciless  ! 

Tin'  amount  eaten.  t<i«i.  was  enormous.  Tin-  Unman  hail  live 
nieai<  a  <iav:  and  at  iri'eat  feasts  when  full  to  repletion,  the  stomach 

Wa-  emptied  ill  order  that  the  ]>|T)ee.-S  (if  tilling  It  llllu'llt  lie  1'c-eulll- 
IHcMced. 

( 'harles  \'.  wa^  ijiute  as  hi;_r  a  glutton  a<  he  was  an  epicure. 
At  a  ilimiel'  of  the  Knights  of  the  (in'alfll  Kleeee  linger  Aseliam  saw 
him  make  hi-  wav  through  .-od  lieef.  roa.-t  mutton,  ami  baked  hare, 
after  wh;>di  lie  fi''l  full  well  (iii  a  capon.  N'or  did  he  forget  lodnnk 
with  it  all.  "  1 1  e  had  hi>  head  in  the  ^lass  li\  e  times  as  l<mtr  :ts  aiiv 
of  thi'tii.  and  di'ank  no  le-s  at  mice  than  a  i|iiart  of  Ilhine  wine." 
NO  wondi-r  he  became  a  /"iiiv  man. 

Then  views  as  to  food  \aried  in  the  widest  manner.  The  Km:- 
li>h  ath!et«'  |«lae(-d  his  faith  in  rare  lieef-teaks  and  raw  eu'Li's  :  while 
the  Hindoo  wrestlers  trained  on  sweetmeats.  The  Kmdish  farmer 
fce.i.-.  hi-  .-ervants  on  meat  in  oi-der  that  thev  mav  lie  eijiial  to  hard 
\voi'k:  ju-t  a-  he  add<  some  extra  eorn  to  the  dietary  of  his  horses 
when  \\orkinLT  hard.  The  hama  of  Stamlmiil  earrie-  meredihie 
\\ei-dits  on  a  du-tarv  whhdi  the  l-'.iiLi'iish  athlete  would  regard  as  nt- 
ti-riv  iiisiitli'Mi'iit  to  support  life  :  and  for  baeksJu'i'sli  is  grateful  for 
a  sliiv  '  >f  mi'ii  '!i. 

( 'ookery-lio(tks  were  written  livnien  of  learning.  l-',\cn  Mr. 
•  lohn^oM.  i  >f  diet  ionar\  fame,  did  not  think  t  lie  .-nlijert  lie  neat  h  him. 

"  1  eollld  write  a  !.^:>-i'  hook  of  .•ookerv  than  has  ever  Vet  heen 
written."  h'-  boasted.  "  It  -hoiild  he  a  book  on  philosophical  prinei- 
ple~."  >o  importan'  did  he  deem  the  ,-u iijeet  that  he  said  i-ontempt- 
iiiiii«!v:  "A  woman  ma\  spin,  but  she  cannot  make  a  ^ood  book  of 
eoo'Ke!-x."  I  I".  Kitelie!!'  i\  the  a  ut  I  lop  of  "  The  ( 'ook  's  <  >raclr.  "  had 
a  l;b'Mi-\  of  \\ork<  de\otcd  to  food  and  eookerv.  consisting  of  no 
!••--  than  '.'•"'"  \olumc-.  It  eannnt  then  be  said  thai  the  subject  ha< 
tii  't  !-i-ci-;vfd  dec  at ;  cni  ion  in  a  i  i  a^c~. 

I'  -  oiiiv  at  r.e  pri-~e]|i  .lav.  and  from  the  teach  HILT  <>f  LiebJLf. 
thai  f'Hid  ha-  arded  fr'-m  a  .-i-ieiit  ilic  point  of  vic\v:  both  as 

i.-:  r\  '.'.  ii  -ii  .-  •_'  ; . • ,  '.IT  '••  -  t  ••  a  rat  ;"Ha!  comprehension  of  t  he  ut  il it  v 
i>:'  :'..od.  a  :•••'.  u  :n- m  cuts  of  ;  h>'  organism.  I'.ct'oi'c  t  hat  da  v  the 

pala'e   Hl'.-d.   alei    ia-:e-    \;iry.         />•      •    <i*lll>nx   I,,,H     il!*i,  nl,i  nil  n,,i  ! 

The    liurtti'  -••    bui';,    ihe;r  i;-!i  until  ;t  i<  putrid,  in  oriler  to  ^j\-,. 

:i  ••    t'n,.    Sandwiidi    I-laiiders  like  i  heir 
-:i  that   tlc-v  de\oiir  ii-K  a.i\e  as  -non  a~  caiiirht. 


THK    OH.IKCT    OF    FOOD.  .", 

Europeans  prefer  ;i  fresh  egg;  in  Cochin  China  the  people  pre- 
fer them  "high."  'The  Israelites  t;ilked  of  ;i  land  of  "  corn  and 
wine"  and  of  "  oil  and  honey."'  The  Egyptians  lived  on  lentiles: 
while  the  Arab  exists  upon  dates. 

The  Hindoo  and  the  Negro  l>oth  delight  in  boiling  rice  and  but- 
ter. ( thee  is  clarified  butter;  and  the  Hindoo  in  praising  anything 
comestible,  couches  his  highest  praise  in  the  phrase  "as  good  as 
ghee!"  On  the  other  hand,  the  (lauchos  of  the  South  American 
pampas  live  solely  on  lean  beef  and  water;  and  Sir  Francis  Stead  has 
told  us  what  power  of  endurance  this  diet  gives.  The  Eskimo  and 
the  natives  of  Northern  Asia  eat  huge  quantities  of  fat,  and  drink 
oil.  This  diet  is  a  perfect  contrast  with  that  of  the  desert  Arab. 
On  the  burning  desert  little  is  required  to  maintain  the  bodv  heat, 
and  a  handful  of  dates  is  sufficient  for  the  body-needs.  On  the  fro- 
zen Arctic  wastes,  fat,  the  strongest  fuel-food,  is  required  in  consid- 
erable quantities  to  keep  the  body  temperature  at  a  point  compatible 
with  life.  Cut  oil'  from  farinaceous  food,  the  Eskimo  rejoices  in  the 
liver  of  the  walrus,  with  its  glycogen,  or  animal  starch:  but  to  give 
it  a  higher  heating  power,  lieeats  it  with  slices  of  fat.  Instinctively 
man  has  adopted  the  dietarv  suited  to  his  needs;  and  the  Anglo-Saxon 
who.  on  the  plains  of  Bengal,  persists  in  the  roast  beef  and  ale  of  Old 
England,  pavs  -the  penalty  of  his  dietarv  indiscretion  in  hepatic 
trouble.  Blindly  and  darklv  then,  instinct  has  guided  man  in  his 
choice  of  food,  before  the  daylight  of  organic  chemistry  came  to  di- 
rect his  path  aright.  Light  has  dispelled  the  darkness:  but  the 
palate  is  not  to  be  dethroned.  There  are  other  things  that  cling  to 
us  as  well  as  original  sin!  The  belief  in  meat  is  ubiquitous  with  the 
Anglo-Saxon.  No  one  can  be  strong  without  meat,  it  is  asserted. 

"  Many  people  seem  to  look  upon  meat  almost  as  t  hough  it  formed 
the  only  food  that  rcallv  nourished  and  supplied  what  is  wanted  for 
work.  The  physician  is  constantly  coming  across  an  expression 
of  tin-  view.  Undoubtedly,  a  greater  feeling  of  satiety  is  produced 
by  meat  than  by  other  food.  It  forms  a  greater  stay  to  the  stom- 
ach, but  this  arises  from  the  stomach  constituting  the  scat  of  its  di- 
gestion; and  a  longer  time  being  occupied  before  it  passes  on  and 
leaves  the  organ  in  an  empty  condition.''  (Paw  on  Food  and  l>ict- 
etics.) 

This  fallacy  is  disproved  by  the  fact  that  the  Sikhs  of  the  Pun- 
jauli  arc  pulse-eaters.  The  halian  lives  almost  solely  on  mai/.c  and 
macaroni.  The  dreaded  I roq uo is  were  cult  i valors  of  mai/.e  a.-  \\  <•!!  as 
ing  Indians.  The  Spaniard  munches  his  onion  and  dit 


MANUAL   OK    DIKTKTICS. 

mist  of  bread  in  oil.  The  Katlir,  like  the  Kirirhis,  lives  mainly  on 
nnik:  as  diil  the  Cvmn.  when  l'a>sar  invaded  Britain.  The  Arab 
has  his  tiates.  The  Hrahmin  ]) refers  t he  banana.  The  Hindoo,  the 
rhine-e  and  tin'  .Japanese,  lind  their  chief  sustenance  in  rice,  which 
with  them  takes  the  place  of  bread  with  us.  liread  or  its  farinace- 
ous eijiiivaleiit  is  the  stall'  of  life.  But  "tliou  shall  not  live  by 
bread  aione"  tells  that  something  in  addition  is  necessary  for  the 
I'm >d  < if  man. 

What  is  that  something?  Milk;  eertainlv  !  Meat?  Xo,  emphat- 
ically No!  Fat.  Yes!— especially  butter.  Some  lluid  is.  of  course, 
r.ece-sarv  as  water.  Here  we  have  all  that  is  required.  There  is 
stan-ii.  body-fuel;  there  is  albumen  for  tissue-repair  in  the  gluten: 
there  arc  earthv  salts,  too.  especially  if  the  bread  he  made  of  whole 
meal:  and  then  there  is  the  fat,  which  partlv  is  burnt  as  body-fuel, 
partiv  cuira^cd  in  the  building  up  of  healthy  tissue. 

Let  us  trace  the  hi.-tory  of  a  mouthful  of  bread  and  butter. 
While  it  is  heini:  masticated,  the  saliva  is  brought  into  contact  with 
many  of  the  starch  granules  (already  cracked  by  the  heat  of  the 
oven  and,  not  onlv  that,  but  a  step  forward  has  thus  been  made  in 
its  solution.)  and  the  conversion  of  insoluble  starch  into  soluble 
siiL'ar  i-  he-j-un.  Then  it  is  swallowed,  when  a  new  action  is  set  up. 
The  soluble  <jrape  sii'_:'ar  of  the  converted  starch  passes  through  the 
wail  of  the  stomach  into  the  gastric  vesicles  of  the  portal  vein:  leav- 
ing 1  he  undissolved  residuum  behind.  The  acid  pistric  juiee  next 
acts  upon  the  gluten,  the  albuminous  stroma,  or  framework  of  the 
ma—  -and  by  dissolving  it.  liberates  the  rest  of  t  he  stan-h  granules 
whi'-h  had  escaped  the  contact  of  the  saliva.  When  the  softened 
mass  passes  the  pvloric  riiiLT.  and  comes  into  contact  with  the  bile 
and  the  secretion  of  the  pancreas,  the  most  active  part  of  the  dip's. 
five  act  sets  in.  The  liberated  starch  granules  come  into  contact, 
w:th  the  diastase  of  the  pancreatic  secretion,  and  are  by  it  con- 
\  ertei]  into  ,-oiuble  Lrrape  siiLfar:  the  digest  ion  of  the  albuminous  suh- 
.-!;ii:'-e-  i.s  further  earned  on  by  the  trvpstn:  the  fat  is  emulsionised 
-i  i- only  digestion.  The  siiLrar.  the  dissolved  albuminoid,-,  the 
earthy  .-alts,  pass  into  the  portal  vein,  to  be  dealt  with  by  the  liver; 
wh.ie  the  fa;  Lr'"bides  pass  by  the  mouth-  of  the  lacteals  into  the 
ivmpliat  ;cs.  Sii'-h  i-  t  he  digest  ion  of  a  t  vpical  mass  of  food  :  1  here  are 
hep',  earl io-hyd rat' -s  |st ;irc h  and  su_trar).  albuminoid-,  fat .  and  eaiM  hy 
.-ails.  And  !••!  nil  th"  art  and  skill  of  all  th"  cooks  who  ever  lived, 
co,!eet.  enok  and  lla\oiir  the  various  ed.ble  substances  of  the  animal 
aiid  vegetable  \\orld,  ///'•-'  arc  the  constituents  of  the  food  of  Man. 


THK    OBJKCT    OF    FOOD.  "» 

The  carbo-hydrates  are  the  body-fuel,  the  surplusage  being 
stored  as  f;it ;  the  albuminoids  serve  to  re  paii'  t  lie  tissues  as  they  war 
out:  the  salts  form  the  blood-salts;  the  fat  helps  t<>  build  up  normal 
health-tissues,  the  excess  being  burnt  as  body-fuel.  That  is  tin-  real 
object  of  food! 

Hut  Nature  bus  veiled  her  object.  She  provides  an  imperious 
palate,  engrafted  upon  an  imperative  sense  of  hunger,  and  the-c  se- 
cure the  nutrition  of  the  body.  Succulent  vein-tables,  luscious 
fruits,  sapid  tlesh:  such  are  the  materials  upon  \vhich  the  cook  exer- 
cises his  art :  and  such  are  the  food  of  the  savage.  While  milk,  t  he 
natural  food  of  the  new-born,  alone  or  in  combination  with  (chiellv) 
vegetable  matter,  is  ever  acceptable.  Hunger  compels  the  individ- 
ual to  take  food  to  lill  the  stomach:  the  palate  guides  him  in  his 
choice;  it'  the  food  be  simple,  there  is  little  or  no  temptation  to  in- 
dulge in  excess.  l>ut  when  the  cook's  art  tempts  tin1  palate,  then 
comes  in  the  temptation.  The  lirst  temptation  came  through  the 
palate — "the  tree  was  good  for  food:"  and  Adam  hearkened  info 
the  voice  of  Kve,  and  ate  of  the  tree— and  the  history  of  human 
troubles  began.  Xo\v.  the  man  has  hearkened  to  the  voice  of  the 
tempter,  and  eats — in  excess  of  his  body-needs.  lie  must  eat  to 
live:  but  that  is  not  the  true  equivalent  of  to  live  to  eat.  The  ob- 
ject of  food  is  the  nutrition  of  the  body — rather  than  the  irratitica- 
t  ion  of  the  palate.  It  may  be  well  next  to  examine  these  different 
constituent  elements  of  food  in  fuller  detail  both  as  to  their  diges- 
tion and  their  destiny. 


(MlAPTKH    II. 

KOIIMS    OF    FOOD  --WITH    TIIKIIL    DKiFSTlOX. 

Carbo-hydrates  Albuminoids  Fat-salts.  Licbi^'s  irivai 
division  <>f  fin  nl  in!  i '  hvdro-carbons.  or  "  fu  1- food, "and  albuminoids, 
ur  "  tissue-food."  though  at  one  time  subjected  to  much  criticism 

has.  in  tin-  main.  stood  its  ground.  Modern  advance  in  physioloii- 
ieal  clieinistrv  certainlv  lias  told  us  that  albuminoids  are  oxidised  in 
their  retrograde  metamorphosis  and  so  contribute  to  the  bodv-heat; 

we  know.  t<><>.  that  fat  is  neeessarv  to  the  formation  of  healthv  i  is- 
sue -as  seen  in  the  rod  liver  oil  so  much  in  repute  for  the  treatment 
of  phthisis-  -and  so  to  some  extent  is  a  tissue-food,  as  well  as  a  fuel- 
food.  Kvcii  certain  salts,  as  the  malates,  the  citrates  and  the  tar- 
trati-s  are  a  fuel  t'ooii.  in  that  the  malic,  citric  and  tartarie  acids 
:uv  oxidised,  while  the  hase  (lar^elv  potash),  appears  in  the  urine 
a- a  carhoiiate  or  mav  he  a  luhate.  The  muscles  re(piire  potash 
and  the  Mood  >oda:  whv  we  do  not  vet  <pute  know.  The  hones  call 
for  lime;  and  admitting  that  Liebijr's  view  is  not  preciselv  accurate, 
it  i-  true  a-  a  broad  division:  and  is  well  worth  bearing  in  mind. 
Wlr. !'  l>e.-aii-e  since  the  davs  when  ('ain  kept  sheep,  and  irave  wav 
to  ungovernable  temper  and  beliaved  l.kc  a  carnivorous  brute,  m 
hi-  murderous  instincts,  man  has  been  tempted  to  take  meat  to 
i_rrat:f\  his  palate,  to  an  extent  far  bevond  his  real  t  issue-needs. 
Man  i-  i;kea  .-team  engine  in  that  he  is  a  piece  of  mechanism  in 
which  -  burnt.  (Vrtainlv  tlieiron  framework  of  t  he  engine 

ru-:-  a  slow  oxidation  and  needs  repair:  and  so  do  the  tissues  of 
man  \\var  out.  I  he  engine  needs  oil  to  lubricate  iH  bearings,  and 
>uiidr\  o'her  matter-  which  ha\e  to  be  cojitinuouslv  supplied  to  \\. 
'Ill-'  animal  >d\  ha-  other  wants  than  mctvlv  "fuel-food"  and 

~-M"-' !.     a       :  '     (or  instance.      The  engine  is  a  means  of  heat- 

n:Lr  water  into     team.  •    •  •        '       -in'_'    that    steam    to    put    wheels 

int"  motion.   >,i..  •  ;o  motor  power.      When  the  eii- 

-'o    much   more  water  and   fuel.       \\  hen 
a  mail  ''\''!'t-  liiin-el;    he  a  .-o  produce-:  more  heat   !iv  increased  o\ida- 

t'."!!    a1    'i     '•'  <','.  -11  Mi  ;   t  :o!|     of      :  food,         Liebi^r   i]o|llitles-    \va-    111     error 

''•   a--M  i!  : :    :   '•  ,.i :    : ::   ac%  ;\  •  .    t  :.«•   a  dm  mi  noid  ti.-sues  art1  consumed. 


FORMS  OF  FOOD.  • 

No  more  than   the   framework  of  a  locomotiye  when  ascending  :in 

incline.  An  engine  doing  hard  work  will  need  more  oil  for  its  lu- 
brication than  one  doing  little  work;  and  probably  will  sooner  have 
to  l)e  sent  to  the  repairing  shed.  A  hardworking  man  may  wear 
out  his  muscles  at  a  more  rapid  rate  than  an  idle  man.  But  all 
the  same  in  the  locomotive  and  the  man,  the  framework  and  t  he  t  is- 
sues do  not  "  burn,"  but  rust,  or  undergo  a  slower  oxidation. 
(In  forming  conclusions  from  the  amount  of  urea — the  body  ash — 
the  perpetual  and  ineradicable  dilrieultv  has  to  be  met  that  urea  is 
the  iinal  soluble  form  of  nitrogcnised  waste  derived  alike  from  the 
///,/  a*  ni//\/i/ti]>tit>ti,  or  surplusage  of  albuminoid  food  and  from  effete 
or  worn-out  tissue.)  Just  as  when  the  body  is  at  rest  its  tempera- 
ture is  maintained  bv  oxidation  of  hydro-carbons,  so  in  activity  the 
combustion  is  the  same;  onlv  greater.  Consequently  the  tissue-food 
for  tissue-repair  actually  required  is  small,  and  more  albuminoids 
are  usually  eaten  than  are  absolutely  needed.  Granting  that  the 
general  health  of  convicts  deteriorates  on  an  insufficient  dietary;  and 
that  the  system  sulTers  when  imperfectly  fed;  and  that  when  work 
is  hard  more  food,  especially  of  the  stimulating  nitrogenised  charac- 
ter is  given,  as  the  result  of  tin;  teaching  of  experience;  still  the 
main  fact  remains  unaffected,  \\z, ,  that  the  actual  wear  and  tear  of 
the  albuminous  tissues  is  small,  and  can  really  be  met  by  a  dietary 
far  less  rich  in  azotised  matter  than  that  taken  by  most  persons. 
Look  at  tin1  lusty  babies  fed  on  '' Pobbs,"  consisting  of  bread  and 
water  (with  little  if  any  milk),  tobe  seen  in  any  agricultural  district 
in  Lngland.  See  the  huge  navvy  "  Lincolnshire  bred,"  reared  on 
bread  and  bacon,  or  dripping  and  potatoes;  or  the  Scotchman  built 
up  on  oatmeal:  and  we  can  understand  that  the  constructive  [towers 
of  the  human  organism  can  successfully  contend  with  great  ditli- 
ciilties.  But  all  the  same,  when  the  navvy  can  procure  snme 
beefsteak  he  can  do  a  harder  day's  work:  and,  I  am  informed, 
that  a  Highland  gillie,  when  lie  shares  the  sportsman's  repast— a 
dietary  superior  tit  that  to  which  he  is  accustomed — waxes  in 
vigour  and  energy,  in  an  obvious  and  unmistakable  manner: 
uhile  1'r.  Kuiiruson  of  Bolton  has  told  us  of  the  improvement  IM 


<  was  added  to  their  bread  and  butter  and 


S  MAN  I 'A  I.   OK    DIKTKTK'S. 

1.   Carbo-hydrates: 

'.'.    .  Mhiiminoids: 

:;.    l-'at: 

With  ;i  small  sub-class — 

4.    Salts. 

Water    MO    is   essential    to   the    body,    but    it  cannot   exactly   bo 

classed  as  a  "  Food.  " 

Carbo-hydrates.-  I'ndrr  the  term  Carbo-hydrates  are  classed 
the  staivhv,  or  farinaceous,  or  amyloid  (as  \ve  choose  an  Knglish. 
a  Latin,  or  a  (ireek  term),  and  the  saccharine  elements  of  our 

food. 

Starch  consists  of  Carbon,  Nitrogen  and  Oxygen  (having  the 
formula  C,H,.(M  and  is  found  in  all  the  cereals:  especially  in  those 
used  as  the  food  of  man,  wheat,  oats,  barley,  mai/.e  and  rye:  it  is 
also  found  in  the  pulse  tribe,  or  legumes,  as  the  pea,  bean,  lentil  and 
the  haricot  bean,  as  also  the  dalil  of  India:  also  in  rice,  buckwheat, 
sago,  tapioca  and  arrowroot,  and  the  quino  of  IVrn.  It  abounds  in 
the  potato,  and  other  roots  (which  contain  the  germs  of  t he  new 
plant),  in  carrots,  parsnips  and  turnips  which  first  produce  a  root, 
from  which  again  a  seed-bearing  stem  is  developed ;  and  is  part  of 
the  unripe  fruit,  which  becomes  sweet  as  the  starch  is  changed  or 
converted  into  sugar. 

Starch  i-  the  food  of  (he  seedling  plant.  To  take  the  case  of  a 
grain  of  any  cereal,  it  contains  starch,  albuminoid  matter,  and 
earthy  salts:  while  oa,ts  and  mai/.e  also  contain  notable  <|iiantitics  of 
fat.  \\  hen  the  plant  '.Terminates  the  starch  is  converted  into  sugar, 
(as  the  liaby  plant  ret  pi  ires  it)  1>\-  the  action  of  the  diastase  (an  al- 
bum iiion-  ferment ).  as  the  seedling  grows.  Insoluble  starch  is  con- 
yerted  into  ,-oluble  sugar  in  the  grain:  just  as  it  is  in  the  human 
mouth.  The  plant  store-  up  food  for  its  young:  and  that  food  man 
take-  fc>r  h!s  own  use.  \\'hv  doe-:  the  store  of  plant  food  take  t  he 
form  of  insoluble  starch?  I>ecause  if  soluble  il  would  be  liable  lo 
be  di--o!ved  liv  water:  and  after  rain  the  grain  field  would  be  bar- 
ren. lii-enuM1  th  •  food  elements  wen-  wa-hed  awav  in  solution.  In- 
soluble -tarch  can  be  stored. 

A  rapid  germination  i-  artificially  set  up  by  the  process  of 
malt  ing":  which  wii!  o.-ciipy  our  at  tent  um  furt  her  t>n. 

\\  In  n  man  ate  un >ked  grain,  as  he  tlid  at  an  early  period  (as 

tiie  worn  molars  of  graminiyorous  men  .-till  tell  us  when  dug  up), 
he  ground  i;  slowly  under  hi-  teet  h ;  and  during  t  his  t  inie  the  starch 
came  i'  contact  with  the  saliva,  which  bv  its  diastase  converted  this 


FORMS    OK    FOOD.  '.I 

starch  into  soluble  dextrine  (with  the  starch  formula)  and  irrape 
sugar  (('  !!,..<  >,,II,O).  The  action  \vas  exercised  upon  tin-  outs  id.-  i.f 
the  starch  granule;  tin-  remainder  passing  <n\  throiiLrh  the  stomach 
till  it  reached  the  diastase  of  the  pancreatic  secretion,  when  it  !><•- 
came  fullv  dissolved.  (All  starch  granules  however  are  not  equally 
acted  upon,  and  where  much  starch  food  is  taken  a  certain  quantity 
of  them  are  to  lie  found  in  the  t\eces. ) 

When  man  came  tirst  to  crush  and  then  to  grind  and  cuok  his 
food,  a  new  departure  took  place.  The  toil  of  grind  im_'  his  ^rain 
was  done  for  him  in  a  less  laborious  manner.  Disintegration  took 
place  in  the  mill,  lie  could  cat,  faster.  Hut  if  no  other  change  had 
gone  on.  this  might  have  been  a  verv  questionable  advantage:  for 
it  would  have  had  the  result  of  filling  his  stomach  with  insoluble 
starch  granules  (a  fertile  source  of  indigestion).  The  effect  of 
heat  upon  the  starch  granule  is  to  crack  it  and  thus  to  form  a  chan- 
nel bv  which  the  saliva  could  reach  the  interior:  an  important  mat- 
ter, lint  another  change  goes  on  of  which  the  knowledge  is  far  less 
general.  The  starch  is  converted,  largelv  into  soluble  dextrine. 
(When  a  portion  of  well-baked  Hour  is  subjected  to  the  iodine  test, 
the  conversion  of  the  starch  is  readilv  seen.)  Consequently  the  fa- 
rina is  speedily  transformed  into  soluble  matters  bv  t  he  saliva.  The 
existing  dextrine  is  carried  forward  to  i^rape  suiiar:  while  the 
remaining  stan-h  is  largely  changed  into  dextrine.  Such  then  is 
the  elTect  of  the  act  of  cooking  upon  the  starch  granule,  (irmd- 
ing  ynd  cooking  lessen  the  labor  of  the  jaws  and  the  salivary 
glands.* 

Disintegration  and  solution  constitute  the  digestive  act.  The 
comer-ion  of  starch  into  ^rape  suirar  is  brought  about  bv  the  sali- 
va rv  diastase  (an  albuminous  bodv  whose  formula  has  not  vet  been 
determined),  bv  a  process  of  hydration:  and  grape  sii'_rar  has  the 
formula)  (  !!..<> ,.II..O).  f.r.,  some  water  has  been  introdueei]  in'.o 
the  molecule.  The  saliva  is  operative  in  the  mouth  and  in  the 
LMillet,  ami  also  in  the  stomach  until  it  becomes  distinctly  ae;d. 
The  soluble  ^rape-sit irar  passes  through  the  wall  of  the  stomach  into 

the   blood. 

This  removal  of  much  of   the   starchy    matter  of   the  food  al'ow- 
the  Moniaeh  toad  upon  the  other  constituent  s.      \\'h''ii  food 
tilv    swallowed,  our    mastication    is    imperfect     from  bad     lee'.h,    ;!),• 


Ill  MA  NT  Ah    Oh"    DIKTKTirS. 

stomach    is   hampered  and   embarrassed  hy  quantities  of  unchanged 
starch,  and  its  digestion  is  slow  and  painful. 

When  the  stomach  becomes  distinctly  acid,  the  conversion  of 
starrh  is  arre-ted.  When  the  stomach  has  done  its  work  mul  gas- 
trie  digestion  is  complete  the  acidity  seems  pretty  much  exhausted, 
and  the  divine  (as  the  pnitaeeons  mass  is  termed)  finds  its  wav  into 
the  duodenum,  \\herc  it  heeoiiit'.s  mixed  with  the  bile  and  the  pan- 
creatic secretion.  In  this  alkaline  medium  the  pancreatic  diastase 
comes  into  piav.  and  the  transformation  of  insoluble  starch  into 
soluble  dextrine  and  grape-sugar  re-commences.  As  the  more  or 
ie.->  disintegrated  or  denuded  starch  granules  pass  along  t he  small 
int'-siiiie  thev  become  1'ullv  dissolved  into  grape-sugar  which  pusses 
into  t  he  blood  of  the  portal  vein. 

Mich  then  is  the  digestion  of  starch.  lint  before  following  up 
the  historv  of  urape  sugar  in  the  bodv.  it  will  be  well  to  consider 
the  ditl'erent  forms  of  sugar.  Sugar  ntav  be  divided  into  crystalline 
or  cam-  suu'.'ir  ((',„!  I ,.( >n)  and  glucose  or  grape  sugar.  The  crvs- 
ta'dinc  sii'_rar  is  the  object  of  the  sugar-baker;  and  the  fares  of  sugar 
lioi!in-_r.  treacle  or  molasses,  are  the  non-crvstallisable  sugar.  On  the 
other  hand  non-er\  stallisable.  or  invert  sugar,  otherwise  levulose,  is 
theobje.-t  of  the  manufacturer  who  supplies  the  brewer  with  sub- 
stitute- fi>r  mall,  ('rvstalline  suirar  is  found  in  the  sugarcane,  the 
be^t  root,  other  roots,  the  maple  and  t  lie  sugar  grass.  Hot  hare 
sweet  to  the  taste;  e rvstal  1  i ne  siiirnr  being  more  intensely  sweet, 
whi.e  the  flavour  of  non-ervstalline  sugar  is  liner  to  most  palates. 
A-  Migar  i-  the  food  of  the  seedling  plant,  so  sugar  is  found  in  all 
\ouir_r  shoots  (notably  in  those  of  the  briar  and  the  grasses,  as  all 
rural  diilil  ivn  kn<  >w  ). 

Although  eane  siiLTar  requires  no  digestion  to  tit  it  for  absorp- 
tion i!  mav  be  eonsnlered  probalilv  that  it  undergoes  conversion  into 
giMjii'-.-ugar.  certainlv  in  part,  if  not  wholly  before  leaving  the  ali- 
incniarv  canal.  If  cane  siiLTar  lie  introduced  into  one  of  the  vessels 
re  n  la  t  ion,  it  passes  oil'  from  the  svstcm  without  lie  ing 
apes.  still  in  the  form  of  cane  sugar  in  the  urine.1 

';.j-;ir   be  introduced  into  the  alimentary  canal 
it  v.  sav,  I'oi- subser|ueiit  assimilation,  sugar  similarly 
.:    j,U]    now  in  the  form  of  Lrrape  sugar  in- 
-  I_M  r.  "     ( \  'aw.  ) 

i,,.  -ti'j'iir      \\hether  dei-ived    from  starchv  or 

i||i        '    .      ,  ''  '  ;       ;J     matters    11"!          paSSCS    lllto    the    pof- 

to    the    liver.      Mere  it  is  dchvdrated,  or 


FORMS    OK    KOOI).  1  1 

turned  buck  into  glycogen,  or  animal  starch  (('  H^OJ.  In  this  in- 
soluble form  once  more  it  can  be  stored  for  the  bodv  needs.  Carbo- 
hydrates then  furnish  the  glycogen  or  bodv-store  of  fuel  in  the  liver. 
The  liver  Mores  up  from  each  meal  so  much  glycogen:  and  ghes  it 
oil'  as  inquired;  otherwise  life  would  be  onlv  one  drearv  meal. 
(Any  disturbance  in  these  glyeogenic  arrangements  leads  to  the  pres- 
ence  of  sugar  in  the  urine.  These  disturbances  may  extend  from 
the  mere  presence  of  sugar  in  the  water  after  a  meal,  when  the  de- 
hvdrating  power  of  the  liver  cannot  keep  pace  with  the  diastatic  ac- 
tivity, up  to  the  dread  disease  diabetes.) 

The  insoluble  store  of  glycogen  is  given  off  as  required  in  the 
form  of  soluble  grape  sugar:  which  is  probably  burnt  upas  lactic 
acid  ((',. H...OJ  in  union  with  soda,  as  lactate  of  soda.  (.Muscles  have 
their  little  stores  of  glycogen;  the  muscles  of  the  embryo  being  es- 
pecially rich  in  it.) 

Such  then  is  the  history  of  the  Carbo-hydrates,  our  great  '"  fuel- 
food":  corresponding  to  the  coal  in  the  tender  of  the  locomotive. 
The  surplusage  of  grape  sugar  forms  the  fat,  or  adipose  tissue  of  the 
body:  a  further  reserve  of  '"fuel-food."  The  store  of  glycogen  in 
the  liver  is  readilv  got  at,  and  so  we  may  liken  it  to  the  coal-scuttle 
bv  the  fireside,  while  the  fat  deposit  is  the  coal  cellar.  In  some 
individuals  it  is  spread  over  the  body  generally:  while  in  others  the 
omentum  and  parietes  of  the  abdominal  muscles  are  its  chief  seats. 

In  some  animals,  as  the  pig  for  instance,  the  fat  is  wide-spread 
and  general,  while  in  the  camel  the  fat  is  stored  in  the  hump,  and 
in  the  codtish  the  liver  is  the  seat  of  the  storage  of  fat.  as  well  as  of 
glvcorjen. 

This  grape  sugar  is  the  natural  bodv  fuel,  anil  where  it  is  burnt 
up,  the  organism  perishes  of  exhaustion:  whether  in  starvation  or 
acute  disease.  This  matter  will  be  further  discussed  when  the  diet- 
etic treatment  of  exhaustion  is  given  further  on. 

Albuminoids.  —  Albumen  is  a  complex  bodv  notablv  containing 
nitrogen.  This  is  t  he  cardinal  matter  which  fits  ii  for  the  noii-oxidis- 
able  framework  of  the  bodv  in  which  the  combustible  hydro-car- 
bons uiv  burnt.  "Of  all  t  he  elements  of  t  be  animal  body,  nitrogen 
has  the  feeblest  attraction  for  oxygen:  and.  what  is  still  more  re- 
markable, it  deprives  all  combustible  elements  with  which  it  c"iii- 
bines.  to  a  greater  or  less  extent,  of  the  [lower  of  combiniiiLT  w;:  h 
o\ \  "vn,  tiiat  is,  of  under^oin^  combust  ion. "  (IJebi^-.) 

1  »v  virt  ue  of  this  nitrogen-factor  then,  the  albuminous  t ;  --.MIC-  arc 
prevented  from  the  body-combustion  extending  t"  them.  Like  the 


1'J  MAM'AL    ('!•'    DIKTKTK'S. 

framework  «>f  the  locomotive  they  ru.*t  hut  »lo  not  burn.  Tlioir 
composit  ion  is  as  follows: 

o  jiA.r^s, 

From  this  we  can  sec  that  thev  differ  from  the  hydro-carbons  in  the 
fact  that  thev  contain  some  sulphur  as  well  as  a  distinct  amount  of 
nitrogen.  The  eg^r  from  which  the  living  bird  is  developed  contains 
alliunien,  some  t'al.  and  water.  Probably  the  shell  furnishes  the 
iime.  White  of  egg  is  typical  albumen.  Albumen  is  found  in  the 
muscles  or  tlesh  of  animals;  it  is  found  in  milk,  as  caseine,  and  in 
all  seeds,  notablv  the  pul.-e  tribe,  whose  seeds  are  rich  in  vegetable 
caseine.  A  certain  proportion  is  found  in  cereals  as  the  gluten  of 
wheat .  for  instance. 

It  is  as  necessarv  for  the  seedling  to  build  up  its  tissues  as  it  is 
for  a  babv.  The  ferment  of  seeds  which  converts  starch  into  ^rapo 
su-_rar.  is  an  albuminous  body.  Albumen  in  a  iluid  form  as  the  white 
of  e^g.  coagulates  and,  forms  a  firm  Avhite  solid  on  boiling.  Vet 
easeinc.  as  in  cheese,  softens  under  heat.  Milk  does  nor,  coagulate 
on  boiling:  but  meal  juice  does.  Consequently  if  an  infusion  of  meat 
be  rai-ed.to  the  boiling  point  the  albumen  is  coagulated.  Hcef  tea 
raised  to  the  boil  and  strained  loses  (with  its  albumen),  what  food- 
value  it  possesses. 

Flesh  cooked  before  the  rigor  mortis  sets  in.  is  readily  masticated; 
and  the  Abyssinian  it  is  said  cuts  his  steak  from  the  living  ox  as  he 
wants  it.  Once  the  rigor  mortis  has  set  in  the  flesh  is  hard  and 
t"iii:h:  consequently  it  is  customary  to  keep  it  until  this  has  passed 
away  before  eookinir  it.  The  cH'ect  of  cooking  upon  muscle  is  to 
Ion-en  the  muscular  bundles  or  fibnlla1  from  each  other,  so  that 
they  are  readily  torn  asunder  and  crushed  bv  the  teeth.  Insuffic- 
iently < ked  meat  is  hard  and  resist-  t  lie  act  ion  of  t  he  teeth :  over 

cooked  meat  is  stringy.  Perfectly  cooked  flesh  is  more  savoury  than 
either  underdone  oi- overdone  meat.  \\dien  taken  into  the  month 
the  muscular  fibre-;  are  torn  asunder  and  crushed  bv  the  act  of  mas- 
tication: so  that  when  t  hev  enter  the  stomach  the  gastric  juice  can 
readily  att;  ".  I  f  meat  be  not  chewed  but  bolted,  t  he  solvent 

tiee  can  o]  •  upon  t  he  exterior  of  the  mass:  while  "lumps" 

I'lTi-nd  tli'1  :  arrest  the  <rastric  secretion,  as  was  found  in 

tli'1  case  of  Ale  ,  St.  Martin.  Solution  is  at  work  under  the  inllu- 
i-!iee  oi  pepsiin  bv  an  acid.  "The  natural  bundles  of  meat 

a1    d    Vegetable-  :  [••     []](>     milSenlar    fibre-    Split     Up    into    discs, 

and  the  protop|a-m  i-      --.  .!ved  from  the  vegetable  cells.  *'    (  M.  l-'oster. ) 

Tiie   a , b'ni. riot; -•    -ii'om  •    o]    bread    or    live]-  is   dissolveil  and    the 


FOKMS    OF   FOOD.  1:) 

starch  granules  set  free;  while  the  albuminous  envelope  of  tin1  fat 
cells  (adipose  tissue)  also  is  dissolved  and  the  fat  is  iH't  free.  Th«- 
food  is  changed  into  a  pultaceous  mass.  '•  such  pieces  as  most  res;.-; 
the  gastric  juice  being  the  last  to  leave  the  stomach."  The  digest  i\e 
action  of  the  stomach  is  exercised  exclusively  upon  albuminoids: 
carbo-hydrates  and  fat  being  untouched.  The  solvent  notion  of  the 
gastric  juice  in  breaking  up  muscular  tibriila-  and  vegetable  matter, 
is  irreatly  aided  by  the  movements  of  tlie  stomach,  which  mil  its  eon- 
tents  about.  While  digestion  is  proceeding  normallv.  a  sense  of 
well-being  and  eomfort  is  experienced:  a  matter  which  has  been 
practically  utilized  by  the  Anglo-Saxon,  who  invites  men  to  a  good 
dinner  before  asking  them  to  subscribe  to  anv  charitable  object.  So 
successful  has  this  been  found  that  it  is  said.  "The  road  to  an 
Englishman's  pocket  lies  through  his  stomach.'' 

On  the  other  hand,  difficult  digestion  has  a  malign  and  untoward 
eil'ect  upon  the  temper  and  disposition,  and  a  stomach-ache  is  per- 
ceptible in  jnanv  of  the  sentences  in  Tom  Carlvle's  writing-.  A 
sudden  shock  will  at  once  arrest  the  muscular  movements  and  the 
gastric  secretion,  producing  a  feeling  as  if  the  stomach  and  its  contents 
had  been  changed  into  a  heavy  hard  substance.  Ouietude  is  con- 
ductive to  good  digestion,  and  an  active  man  should  .-;t  or  lie  do\vi, 
after  a  good  meal — just  as  his  dog  does!  Animals  Jill  their  stom- 
achs and  then  lie  do\vn — not  having  the  ambition  of  man.  or  bein^ 
interested  in  the  absorbing  acquisition  of  wealth. 

As  digestion  proceeds  the  pyloric  ring  relaxes  and  t lie  chyme  find- 
its  wav  into  the  duodenum.  The  aciditv  of  the  stomach  seems  to 
exhaust  itself  in  the  digestive  act.  and  the  divine  is  readilv  rendered 
alkaline  bv  the  bile.  In  this  alkaline  condition  albuminoids  are 
readilv  acted  upon  by  the  trvpsin  of  the  pancreatic  secretion  wind; 
completes  their  solnt  ion. 

.1  u -t  as  we  saw  t  hat  starch  is  dissolved  bv  hvdrat  ion.  so  is  an  albu- 
minoid. An  albuminoid  previous  to  sol ut  ion  is  termed  a  "  protcid. " 
When  rendered  soluble  bv  the  digestive  act  it  is  called  a  "peptone. " 
It  has  been  rendered  soluble  bv  hydration  so  that  it  inav  pass  through 
the  wall  of  the  alimentary  canal,  and  enter  the  portal  vein.  II;;:  a- 
a  soluble  peptone  would  a <  steadilv  slip  out  of  the  circulation  '< 
the  kidnevs  as  it  linds  its  wav  in  bv  the  portal  venules.  it  is  dehv- 

dratei]   and    once  more  made  a  proteid    in  the  porial    b! 1.      (  \\  !;.•:: 

this  does  not  take  place  properly  the  peptone  appears  in  the  urine 
as  "  fa l.-e  "  albuminuria. ) 

When  the   albuminoid    matters  reach  the  liver,  a  certain    proo.>r- 


U  MANTAL    OK    IMKTKTICS. 

tion  i-  elahorateil    into    t  he  serum-albumen  of  the   ?t'r/nnr  ttfiHf/nini* 

for  the  nutrition  of  the  tissues.  But  as  the  framework  of  the  loco- 
motive needs  little  repair,  so  the  albuminous  tissues  of  the  animal 
bi .,  iv  iv<  mire-  little  repairing  material  from  day  to  dav.  A  suttic- 
ieiiev  can  be  found  in  a  dietary  far  below  what  is  ordinarily  eaten  bv 
man.  and  especially  eivilized  men.  For  fifty  years  Lewis  Cornaro 
iued  in  health  and  strength  and  vigour  on  fourteen  ounces  of  food. 
mostly  vegetable,  and  twelve  ounces  of  liijfht  wine  dailv.  I  have  a 
su-['icion  that  the  said  Lewis  Cornaro  belonged  to  that  stalwart  and 
.-"inewhat  corpulent  race  of  man  of  whom  it  mav  be  sai.l  ''that  the 
le.-s  t  hev  eat  a nd  drink  t  he  better  they  are,"  and  who  frequently  are 
•_:' \ "ci tsnrie.  But  allowing  for  this,  it  can  safely  be  said  that  most  people 
gratify  their  palates  bv  consuming  more  albuminoid  matter  daily  thai) 
their  bodies  act uallv  rcimire.  This  surplusage,  is  called  the  "  In.riis 
1-u/i.vi/iitfiftii/i."  \\hat  becomes  of  this  litstt*  t'OuxuMjitian?  It  is 
burnt  up.  and  oxidixed  in  a  descending  series  as  tvrosin,  leucin. 
kreat:ne,  kreatinine.  passing  on  to  uric  aeid  and  urea.  It  is  uniiee- 
es.-ary  to  ^ive  the  formula1  of  these  different  substances,  except  uric 
aeid  (('  ILVO,)  and  urea  (MI.. .CO).  ''  The  antecedents  of  the  urea 
in  blood  are  in  all  probability,  partly  the  kreatin  Formed  in  the 
muscle  and  elsewhere,  partly  the  leucin  formed  in  the  alimentary 
canal,  a-  well  as  in  various  tissues."  (M.  Foster.) 

Thi-  i-  a  piece  of  phvsiolo^v  of  which  we  have  as  vet  but  broken 
h'_rh;s.  It  i-  cnoiiLih  for  the  present  consideration  that  tissue  waste 
and  albuminoid  excess  are  burnt  up.  (mainly  in  the  liver)  into  the 
abo\  i--name(!  product,  of  retrograde  albuminoid  metamorphosis.  And 
wMli  these  e\ercinent  it  ions  matters  the  physician  has  much  to  do, 
e-pci  sal  1  v  a-  \  car-  ad  \  a  nee.  \\  e  all  know  tin-  sen  sat  ions  of  well-be- 
;v_r  1 1  rod  need  bv  a  u-ood  meal,  under  t  he  act  ion  of  a  competent  ditT(1>- 
t  on;  ei  ation-  which  have  ever  had  a  potent  attraction  for  the 
A  TI'_VO  >a  \on  race,  \\  ;:  h  whom  //ni/t  /•/  rim  nx  ririt/Hifx  ha-  been  largely 
a  rn'ei'!'  conduct.  But  when  the  diirest ion  of  albuminoids  is  not 
.  then  the  case  i<  widely  different.  Mr.  Lander 

Brnntnii.  I-'.  U.S..  In-  -hown  that  peptones  in  the  general  eireiila- 
'  "ii  a-  •  nii;  and  when  the  liver  is  deranged  toxic 

•     lV    "  a  re  fi  irined  which  remh-r  t  he  indi  vid- 
:;:u  u  rr  i.-h-'-i.  i  ;ii   ea-e. 

••  ;st   Lra\e  me  a  verv  vivid  account  ojie  day 

"t  !!:'•  i-;]'i  .  n   her.       ,\i   lirst   -he  had  the  wnnted  sense 

two    hour-  after  the  meal    lh:s  pive  way  to 
a    t>  ••-.(.[  v  oppc,-;].-    ci,.i,i;t  ion  of  -n    and    sense  of    mi-cry  and 


FORMS    OF    FOOD.  l.~> 

impending  evil.  This  condition  is  not  uncommon,  tin- ''  liver  stutTs' 
or  mill- products  of  deranged  hepatic  action  having  tin-  oppo.-itc 
effects  of  the  normal  products  of  digest  ion. 

The  question  may  now  he  put:  "  How  is  it  that  nearlv  all  of  us 
eat  too  much  meat,  or  its  equivalent  and  vet  onlv  a  certain  proportion 
sutTer,  as  beinir  hilious  or  <routy  ?  "  The  question  is  a  pertinent  one. 
The  liver  possesses  a  <rood  deal  of '' spare  power  "  as  the  late  I  >r. 
Murdiison  happilv  phrased  it,  and  is,  usuallv,  equal  to  dealing  suc- 
cessfully with  a  quantity  of  albuminoids,  far  in  excess  of  the  body 
needs.  The  answer  is  then  "  So  lon<r  as  the  liver  possesses  the  power 
of  converting  this  hi.nis  I'tnixii ur/ttiun  into  soluble  urea  ail  is  well  !" 
Soluble  urea  passes  out  of  the  liquor  sanjruinis  in  the  renal  secretion 
without  anv  difficulty.  But  not  so  uric  acid. 

I'rca  belongs  to  the  warm-blooded  mammalia  with  a  fluid  urine; 
while  uric  acid  is  the  form  of  excremeiititious,  nitroirenised  matter 
in  the  warm-blooded  bird  and  the  cold-blooded  reptile.  In  other 
words  urea  belongs  to  the  animal  with  four  chamliers  to  the  heart; 
while  the  tri-chainbeivd  heart  is  found  with  uric  arid.  So  loner  then 
as  the  liver  can  convert  the  IHSHS  ronsinn/ittu/i  into  urea  so  lon*r  can 
man,  yes.  and  woman  too,  eat  albuminoids  in  excess  of  their  body 
wants:  but  when  this  power  wanes,  and  products  beloniriu<r  to  a 
lower  stratum  of  creatures  are  formed,  then  it  becomes  time  to  pull 
up  and  diminish  the  nitnureni/ed  elements  in  the  dictarv.  And  if 
this  be  not  done,  irout  in  some  of  its  Protean  forms  will  show  itself. 
Uric  acid  is  the  poison  of  irout:  and  when  it  is  formed  in  any  quan- 
titv  in  the  body  then  a  condition  of  lithisis  or  litluemia  supervenes. 

As  to  the  cause  of  this  impairment  in  the  functional  power  of  the 
liver,  it  may  be  said  that  loiiir  continued  over-work  in  dealing  w.th 
excessive  quantities  of  a/.otised  food  is  the  cause  /uir  r./vW// -n<->\  It 
may  not  be  the  act  of  the  individual  but  that  of  an  ancestor.  The 
father  mav  indulge  in  excess,  and  the  son  sull'er  for  it  in  the  form  of 
an  inetlicient  liver.  "The  fathers  have  eaten  sour  grapes  and  the 
chiidi'en's  teeth  are  set  on  ed^c!  "  Verily,  it  is  so! 

There  are,  however,  other  mat ters  of  albuminoid  descent  and  lin- 
eairc.  that  must  not  escape  our  atlent  mn;  these  are  the  bile  acids. 
I5oth  contain  nitrogen:  and  one  contains  sulphur •— ample  pi'iioN  ot 
their  oritriu!  Clycoeholie  acid  has  the  formuhi  (('..,11,  N'O  I:  and 
tan i-ocholie  acid  ((',,  IL.XSJ)).  Sonic  persons  sull'er  from  ' 
mia  "  while  others  sit tl'er  from  "  ] itluemia  "  when  their  liver-  are  out 
of  order.  Further  some  persons  who  are  "  hi i ions  "  m  eari\  ii!e  ;o.-e 
their  biliousness  and  become  "  polity ''  in  middle  a^'e.  I'holo-mia 


Iti  MANUAL   OK    PIKTKTK'S. 

and  litha'inia  equally  and  alike  are  causally  related  to  the  albuminoid 
elements  of  our  food.  Indeed,  the  products  of  retrograde  nitrogen- 
ised  metamorphosis  are  fertile  sources  of  disorder  and  disease.  Dr. 
(icorge  .Johnson.  K.  K.S.,  has  pointed  out  that  kidney  disease  is  set 
up  bv  hepatic  mal-products  passing  out  in  the  urine  and  in  doing 
so  irritating  the  kidnevs:  and  has  written  this  trenchant  sentence — 
"  fii'/ut/  i/i'i/i  //!'/•(// in//  /.v  ii  f<nixf'i/t')i<'>'  of  {lit1  lout]  continued  eUininn- 
tioii  of  j>rtnl  in'{s  <>f  f<t  nit  if  digestion  //irony//  tin'  *  kidneys." 

There  can  be  no  doubt  iu  the  mind  of  anyone  who  has  had  the 
opportunity  to  observe  and  has  availed  himself  thereof,  that  when 
lithates  abound  in  the  blood  one  of  two  things  happen:  either  some 
remain  in  the  body  as  gout;  or  the  kidneys  become  inured  by  their 
output  of  lithates  (the  common  origin  of  Bright's  disease),  or  may 
be  more  or-  less  of  both  are  found.  Many  persons  pass  turbid  urine 
laden  with  lithates  for  years  apparently  none  the  worse:  but  all  the 
same  their  doom  is  before  them.  Sooner  or  later  mischief  in  the 
kidneys  is,  set,  up.  We  pay  a  price  for  pleasing  our  palates! 

The  ell'ects  of  food  tell  us  that  there  are  certain  properties  con- 
nected with  animal  food  lacking  in  other  dietetic  matters.  The  her- 
bivora  are  widely  different  in  disposition  and  build  from  the  carnivora. 
The  beef  of  the  Kngiish  soldiers  and  sailors  has  played  a  part  in 
their  exploits,  it  has  always  been  said.  Liebig  has  written — ''  It  is 
certain  that  three  men,  one  of  whom  has  had  a  full  meal  of  beef  and 
bread,  the  second  cheese  or  saltlish,  and  the  third  potatoes,  regard  a 
difficulty  from  entirely  different  points  of  view." — Dominie  Sampson 
was  another  man  after  some  of  the  contents  of  the  (iipsy's  cauldron. 
Refractory  boys  of  old  were  subdued  bv  a  dietary  of  bread  and  water. 

(Granting  all  this,  it  is  impossible  to  disagree  with  Dr.  I'avyin 
holding  that,  the  advantages  of  a  meat  dietary  have  been  much  exag- 
gerated and  overrated.  He  points  to  the  fact  of  the  oatmeal  and 
milk  of  the  Scotch  peasantry.  Certain  reports  of  the  prison  diet- 
aries are  referred  to  by  him.  Dr.  (Juy  states.  "  That  we  possess  con- 
elusive  evidence  of  the  sufficiency  of  a  diet  from  which  meat  is  wholly 
excluded :  and  even  of  a  diet  consisting  wholly  of  vegetable  mat  ter.  " 
Dr.  I'avv  is  careful  instate  that  he  does  not  advocate  a  non-meat 
dietary,  but  H  oppn-ed  In  the  prevalent  view  that  a  certain  quantity 
ot  meat  i-  nece-^arv  to  vigour;  and.  the  outcome  thereof  of  the  prin- 
ciple, that  ''  it  i-'  impossible  to  have  too  much  of  a  good  tiling."  vi/. . 
eating  rimrc  meat  than  is  either  necessary  or  good  for  the  system. 

There  i-  another  a.-pcet  of  meat  to  lie  considered,  viz.,  the  com- 
parative digest  ibi  lit  v  of  the  various  forms  of  flesh  which  mu-t  be  di.-- 


cussed  at  some  length  in  a  future  chapter  dealing  with  indige-t  ion. 
Dr.  1'avv  lias  given  us  a  reasitn  for  tin-  taste  for  meat,  to  tin-  ell'ect 
that  t  lie  stomach  is  the  seat  of  its  digc-t  ion,  aiui  t  hat  meat  stays  lom_r 
in  the  stomach  before  leaving  it.  (Vrtainlv  in  the  case  of  .\ie\i- 
St.  Martin,  a  Canadian  soldier  in  the  I'.  S.A.  army.  who-e  stomach 
was  laid  open  hv  ;i  charge  of  duck  shot,  at  the  distance  of  one  yard, 
at  M  ichillimackinac  in  IS  •.'•.'.  and  who  survived  the  wound.  thi-  was 
the  ease,  For  some  months  the  patient  sulTered  terribly  from  ex- 
foliation of  the  ribs,  etc. .  but  t  hanks  to  an  iron  const  it  tit  ion  he  rude 
out  the  storm.  In  a  year  the  injury  had  healed,  except  that  the 
stomach  wound  did  not  close,  and  he  had  to  wear  a  bandage  over 
tlu- wound  to  prevent  his  food  from  escaping  out  of  the  stomaeh. 
A  little  later  a  fold  of  the  lining  of  the  stomach  developed  into  a 
valve  which  closed  the  orifice,  preventing  the  escape  of  the  contents 
of  their  visciis.  but  readily  pushed  inwards  by  the  linger,  and  so  ad- 
mitting a  view  of  what  was  going  on  in  the  stomach.  1  >r.  Beaumont . 
his  medical  attendant,  paid  him  the  most  scrupulous,  attention:  and 
in  return  St.  Martin  permitted  him  opportunities  for  inspecting  hi- 
stomach  when  in  action.  The  case  created  an  immense  attention  at 
the  time,  but  is  now  disappearing  from,  our  literature.  1  >r.  Beau- 
mont found  that  beef,  mutton  and  pork  took  three  hours  for  their 
digestion  in  the  stomach  of  St.  Martin,  and  cheese  three  and.  a  half: 
but  for  the  latter  a  much  longer  time  would  be  required  with  some 
stomachs.  1 1  is  broad  results  were  that  the  ilc-h  of  animal-  is  no, 
quicklv  digested.  His  conclusions  remind,  mr  of  the  heart v  eater 
who  after  an  ample  tish  dinner  remarked  that  "  he  felt  <juite  ivad\ 

for   a    beef-leak.  " 

Of  albuminoid  food,  and  especially  the  ilesh  of  animals,  "  li-h. 
tlesh  and  fowl."  it  mav  lie  said  that  it  is  agreeable  to  the  palate  and 
grateful  to  the  stomach:  and  further  that  it  is  excellent  material  on 
which  the  cook  can  exercise  Ins  -kill,  and  consequent  Iv.  that  r,  is  a 
tempt  ing  viand :  that  it  is  a  stimulant  in  its  character  and  i-ih'T<'- 
fofe  special!  v  su  it  ed  for  1 1  lose  who  lead  a  i  i  !'••  of  Lfrcat  phvsical  act  i\  :i  v. 
But  that  it  is  not  suited  for  I  ho-e  \\h"  iead  an  indolent  or  -cd.-ntavv 
life;  and  that  most  of  th.e  maladies  which  fa-ten  on  the  bod\  a-  ..•_. 
approaches  are  can. -ail  v  1  inked  with  the  presence  of  an  e\ce-s  of  a 
miiioid  waste  in  the  blood. 

Fats.      'I'he  third    LiTeat  element   of  our  fei 

far  inor>-  carlion  and  much    less  o\\u'en  than  the  e;irbi  •  •-. 

has   t  he  formula  ((',   II  ,.<  >.  )      Fat    can   hardlv    be    -aid    ; 
but    rathei1  can   be  broken  up  into,  a   fatt\   aci  i  a'.<;    :'i  \  >->T\  >[.•.      The 


MAM   A  I.    <>K    IMKTKTICS. 

t'aitv  afiils  ;ir«'  t  hive,  stearic.  palnnt  ir.  anil  oleic.  Stearine  is  the 
lii'iiH-s:  fat,  ri-;i«lilv  u'oiiii;'  solid  at  a  low  tempera! ure.  \vhileoleine  is 
.-till  iiuite  tluiil:  anil  palmiiis  stands  between  tin-  two.  The  matter 
is  ivaililv  seen  in  a  bottle  of  olive  oil  in  eolil  weather.  Animal  fat 
contains  a  larp.T  proportion  of  stearine.  ami  mutton  and  beef  suet 
iiuii-klv  ^0  hard,  liroadlv  speaking,  t  lie  digestibility  of  a  fat  is  linked 
with  the  proportion  of  steai'ine  it  contains,  and  with  the  tempera- 
ture at  whieli  the  fat  pies  linn.  Thus  beef  and  mutton  suet  an; 
les<  dip'stihle  than  butter  or  lard;  while  the  best  cod-liver  oil  has 
its  stearine  removed  by  free/in^. 

Fa!  is  derived  from  animals  and  vegetables,  both  as  fats  and  oils. 
Whale  oil  is  too  rank  for  food,  at  least,  for  ordmarv  men:  though 
the  Fskimo  revel  in  the  blubber  of  the  whale  and  the  seal.  ('<><!- 
li\  er  oil  is  not  attractive  to  the  palate,  though  some  persons  overcome 
their  dislike  to  it.  until  they  take  it  readily:  and  a  small  number 
even  profess  to  like  it.  Palm  oil  when  fresh  is  palatable,  and  is 
freelv  eaten  bv  the  negroes  of  New  (Juinea.  The  oil  of  the  African 
LTi'iuind  nut  is  a  verv  thin  oil,  used  to  thin  down  and  to  adulterate; 
other  ods.  Olive  oil  is  used  in  cooking,  as  frvinu'  lish.  and  for  sal- 
ads; but  then-  are  reasons  to  believe  that  rape-seed  oil  is  larp-lv  sold 
as  salad  oil.  Man  v  seeds  are  rich  in  oil.  as  1  in  seed  :  wh  lie  some  nuts 
abound  in  oil.  The  cocoa-nut  and  the  Bra/Mian  nut  of  commerce  are, 
instances  in  point.  \\hvsitch  quantities  of  a  concentrated  hvdro- 
earbon  should  be  requisite  in  the  case  of  certain  seeds  in  tropical 
climates  it  is  not  easy  to  see.  Nor  is  l  he  passionate  liking  for  fat, 
as  ,-eeii  jn  t  he  1 1  indoo's  much-pi  ixed  '_fhee  and  the  equatorial  negro's 
fondness  for  palm  oil  as  readily  intelligible  as  is  the  Fskimo's  pref- 
erence for  blubber,  which  is  shared  bv  the  Ya  knots  of  Northern  Asia. 

Fa;  is  a  very  concent  rated  fuel-food ,  and  is  t  he  form  of  storage  of 
.-urplii-  food,  ehieflv  derived  fnnii  the  carbo-livdrates.  The  hyher- 
natini:  animals  retire  laden  with  fat.  and  emerge  from  their  hiding- 
place-,  pi  u  nt  and  emaciated  like  the  pi"_-  1m  r  led  under  the  chalk  c!  ilf 
of  l>o\i-r.  which  I  >r.  Mantel!  lias  mad"  famous.  Ilisstv  was  a  cave 
:n  tli''  .-olid  roi'k.  under  a  <-haik  ciiiT;  so  that  wln-n  a  lar^e  portion 
"!'  tin-  e  '  .  ie  \vas  buried  alive,  lie  \\a~  ''-tmialed  to  u'ei^h 

about    I  i'ii i    --.  i-  accident  occurred:   of   course  no  hope  of    his 

sun   •  •  nti  rta  tied.   \>\\\    \  In   davs  later  tin-  \vo]-kmen    removing 

the  '.  lie.  and  pit   him  out  alive;    hut  old v  wei^h- 

;n'_r   I11        .       \ ••'    In-  must    have  perished    bin   for  tin-  nioi-ture 

win.  li  i          •  ii   the    roek\   -ides  of   his  cave.       I  hiring   this    i")!^ 

p,  .;•.,„  i    ii,^'j-\  nwii    fat.      'I'he  Tvroli-.-e  chamois  hunier 


FOKMS    OK    Fool).  l;t 

lias  found  by  experience  that  a  piece  of  beef  suet  is  the  iicst  and 
least  cumbrous  food  lie  can  carry  with  him  on  to  tin1  mountains. 
His  choice  is  a  wise  one. 

Fat  is  not  affected  l>v  salivary  nor  yet  by  pistric  digestion.  It  is 
onlv  when  gastric  digestion  is  over,  and  fat  conies  into  contact  with 
bile  and  the  pancreatic  secretion,  that  anv  change  is  effected  in  it. 
The  change  is  not  molecular  like  the  hydration  of  carbo-h  vdrat<s 
and  albuminoids;  hut  is  merely  an  emulsitication,  /./'.,  a  division 
into  minute  particles.  These  tine  particles  are  small  enough  to  enter 
the  months  u  f  the  lac  tea  Is  in  the  uitest  inal  villi.  which  ma  v  be  said  to 
"  eat  "  the  fat  globules.  l-'rom  thence  the  emnlsioniseil  fat  passes 
on  to  the  lymphatics.  The  history  of  fat  in  the  bodv  after  this  is 
obscure:  we  know  that  some  of  it  is  taken  bv  the  tissues,  and  the 
rest  is  burnt  up  as  bodv  fuel.  There  is  no  proof  of  fat  beini:  .-ton-d 
up  in  the  bodv  as  fat.  Indeed.  Kbstein  has  advocated  the  sub-titii- 
tion  of  fat  for  carbo-hydrates  in  the  treatment  of  obcsitv;  and  that 
too  with  success. 

The  difficulty  with  fat  lies  with  the  stomach.  A  delicate  fastid- 
ious stomach  is  offended  by  the  presence  of  fat  in  it:  and  this  re-acts 
upon  the  palate.  Some  stomachs  will  tolerate  cold  butter,  which 
promptlv  and  pronouncedly  take  offence  at  warm  fat.  Ifancid  fat 
is  objectionable  to  all  civilized  stomachs:  and  compels  the  most  scru- 
pulous attention  to  all  culinary  utensils.  With  some  persons,  fat 
turns  rancid  in  the  stomach  bvthe  formation  of  an  a'-rid  acid. — 
butvrii  —  causing;  heart-burn.  There  is  a  ^rowin^  dislike  to  fat, 
especiallv  animal  fat.  at  the  present  time.  Manv  children  will  no 
more  eat  fat  than  will  the  cat.  They  will  turn  with  loathing  from 
the  sweet  pieces  of  fat  on  their  plate-,  yet  thev  will  readilv  swallow 
the  lishv  cod-liver  oil.  Their  choii-e  is  instinct  ive,  and  evidently 
linked  with  the  fact  that,  thev  can  digest  the  one.  but  /«//  the  other. 
The  fact  remains;  and  1  >r.  KiiiLT  Cham'-crs  tells  the  Morv  of  a 
phi  hisical  Scotch  terrier  who  whined  at  til:- door  of  the  cupboard  in 
which  hi-  cod-liver  oil  was  kept,  if  ;t  wa-  l'ori_r<>Men. 

The  late  1'rof.  .1.  Hughes  llctinett  of   Kdinbiir_yli  tir-t  inlroduceil 
the    use  of  cod-liver  oil    into    the  treatment    of    phthi-;-.      There 
nothing  magical  about   it.  it.  is  merelv  the  mo-;  digestible  form  of  fa:. 
Still,  it  is  a  mi^htv  matter  in  dealing  wit h  wa~t  inir  d  isea-o.     Tiic  .  Selec- 
tive tissues  of  stroma  improve  under  I;.      The  phthi-ica!   pa!:e-, 
(pientlv    linds  in  it    the  mean-  of   -^tavMiu'  hi-    ilisea-e.      Tak'  • 
an  hour  and  a  half  after  meal-;  il  ijUickiv  parses  out  of   ti!<  ii, 

and  so  Lfivi's  that  viscus  little  oil'cncc.      Taken  In-fore  a  !;•:.-•         •  M 


L'<>  MAM   AL    <•!•'    DIKTKTK  S. 

immediatelv  lifter,  it  eructates  and  disagrees.  H'H  taken  at  the 
time  when  tin-  disintegrated  food  is  passing  out  of  the  stomach,  it 
ouieklv  reaches  the  point  when  fat  is  dealt  wit h  in  the  aliinentarv 
canal.  I>ut  in  some  cases,  especiallv  when  the  bowels  are  the  scat  of 
tubercular  disease,  the  oil  is  voided  m  -//^/.v\r  and  unchanged.  Here 
the  paiHTi  as  is  clcarlv  unequal  to  dealing  with  it;  and  it  is  useless 
to  persist  with  it. 

From  tlie  fact  that  fat  is  emulsionised  in  the  intestines,  chemists 
have  heen  led  to  mutate  nature,  and  form  fat  emulsions.  In  milk, 
fat  exists  in  the  form  of  an  emulsion;  and  the  addition  of  a  certain 
amount  of  milk  to  the  dietarv  provides  fat  for  healthv  tissue  forma- 
tion, in  persons  wit  h  the  most  tetchy  stomachs.  Or  cream  with  a 
little  flavouring  like  maraschino,  mav  he  taken  about  an  hour  after  a 
meal.  P>v  so  do;iii,r  in  maiiv  eases  it  does  not  become  necessarv  to 
resort  to  cod-liver  oil.  Fat  emulsions  are  more  digestible,  or  rather 
assimilable  than  unemulsionised  fats  and  oils.  There  are  many  fat 
emulsions  in  the  market,  of  varving  value,  and  various  flavours, 
lly drol cine  and  oleochyle  are  cases  in  point.  Hut  there  is  a  difficulty 
in  keeping  them,  as  sooner  or  later  the  emulsion  separates.  One 
specimen  I  had  for  three  years  before,  it  began  to  part:  but  for  sun- 
drv  reasons  |  have  no  intention  of  giving  Us  owner  a  gratuitous  ad- 
vertisement bv  mentioning  it  here.  In  other  eases  the  oil  has  been 
mi  \ed  with  malt  ex  t  ract :  and  t  liouirh  this  1:1  ves  an  emulsion  of  coarse 
oil-^lobnles,  in  time  the  oil  gets  to  the  top.  Then  in  the  (,'remor 
I  lordeat us  of  Leollnnd  the  emulsion  form  of  fat  is  preserved;  ami 
Oleobyne  is  an  emnlsionised  fat.  These  last  contain  fat  with  soluble 
carho-hvd  rates,  and  are  palatable  as  well  as  being  capable  of  being 
kept  for  ahv  length  of  time  in  their  tins.  Such  preparations  are  in- 
dicated where  the  palate  objects  to  cod-liver  oil;  indeed  the  fat  in 
both  cases  is  a  better  fat  than  the  oil;  while  the  form  of  emulsion  is. 
favourable  to  assimilation.  Thev  form  indeed  vei'v  complete  fooiis 
for  in\;i!ids  and  travellers.  \Vitha  little  farinaceous  matter,  as  a 
.  ud  a  little  milk,  thev  are  well  adapted  to  goutv  persons  and 
tho.-e  who  -ulTer  from  Uri^ht's  disease. 

Fat-eat  m'_r  amoiiLT  adults  is  fort  UliateiV  on  the  increase  at  the 
present  day;  if  the  valuable  hvdro-earbon  is  in  growing  d:-fa\oiir  in 
the  nursery.  Intelligent  person-  ai'e  now  eating  fat  because  ihcv 
know  11  is  ^ood  for  them.  \\"heiie\ cr  there  is  aii\'  leiidenev  to 
tubercle,  the  individual  should  learn  to  eat  fat.  ju-t  as  a  seafaring 
man  learns  to  ~wim.  A--  a  jihvsician  to  a  Chest  Hospital  1  have 
learned  to  dread  the  announcement  that  fat  is  no  longer  taken.  es_ 


FORMS    OF    Fool). 

peciully  if  the  individual  is  of  shannons  build,  with  :i  small  narrow 
chest.  In  inv  opinion  the  existence  of  a  considerable  an -a  "I" 
affected  lung  where  the  digestive  powers  keep  up.  is  less  fraught 
with  evil  and  less  prognosticallv  significant  than  intractable  wasting 
with  verv  little  disease  in  tin-  lung. 

The  statement  often  made  t  hat  ''  fat  is  hi  lions,"  as  he  ing  a  direct 
irritant  to  t  he  liver,  is  ineonvet. 

Certain  it  is  that  when  the  dietary  is  improved  in  some  eases  the 
liver  is  upset  hv  the  ne\v  demand  upon  it:  but  this  can  alwavs  be 
met  by  a  cholagogue  and  a  purgative. 

Salts.  -Certain  nun-game  principles  are  also  essential  to  our 
health,  mainlv  chlorides  and  phosphates.  When  certain  vegetable 
salts  are  lacking  in  the  dietarv.  the  disease  known  as  scurvy  is  in- 
duced. The  early  navigators  of  the  oceans  which  lave  the  shores  of 
the  new  world  were  terrihlv  alllicted  with  scurvy,  in  consequence  of 
their  dietary  of  biscuit,  and  salted  meat.  Anv  vegetable  matter, 
especially  "  scurvv  "  grass  (cochlearia  ollicinalis)  a  member  of  the  ( 'ru- 
cit'era1,  at  once  brought  relief.  Land  scurvv  is  occasional  1  v  seen  in  pel-- 
sons who  abjure  vegetables,  as  do  some  dvspepties.  A  cruel  old  I  Mitch 
punishment  was  to  feed  prisoners  on  bread  made  wit  hunt  salt.  Much 
obscurity  still  overlavs  the  1'u  net  ions  of  t  hese  hod  v- salts.  "  \\'e  know 
that  t  he  various  saline  bodies  are  essential  to  health,  that  when  the\- 
are  not  present  in  proper  proportion-,  nutrition  is  aH'ected,  as  is 
sh>,wn  hv  certain  forms  of  scurvv:  we  are  aware  of  the  peculiar  de- 
pendence of  proteid  natalities  in  the  presence  of  salines:  but  hcvond 
this  we  know  verv  little."  (M.  Foster.)  A  vyood  illustration  of  the 
value  of  the  body-salts  is  furnished  hv  watching  the  effects  of  arrest- 
ing the  night  sweats  of  phthisis.  A-  soon  as  the  out  pop  I'lnir  of  the 
salts  in  the  sweat  is  checked,  the  appet  he  returns  and  soon  the  pallor 
"!  the  features  gives  wav  to  the  hue  of  returning  health.  The 
etl'cct  ]s  often  almost  magical.  Chloride  of  sodium,  our  common 
salt,  is  a  palatable  addition  to  our  viands  and  especially  to  the  tlr-h 
ot  animal-.  I'robablv  from  it.  is  furnished  the  hydrochloric  ac;d  of 
the  gastric  juice;  while  the  soda  goes  to  the  livei'.  as  the  alkaline 
hascof  theglyeocholates  and  taurocholates  ,,f  the  bile.  The  ph,,~ 
[iliales  too  are  eijuailv  important.  Phosphate  of  lime  -  iv.,u  :-:•>•  tor 
the  bones  of  the  body,  and  is  t'urnisliei]  by  the  cereal-  of  o<;:- 

conspicuous  for  tin-  tenacity  with  which  It  holds  a  larjv  inian:  :\  of 
phospliatc  of  lime  incoi'po rated  with  it."  i  1  'a\  v.  i 

It    i-    found   indeed    in    all    the  structural    cl"in.".;-  <>: 


L'-J  MAMAL    <>!•'    I  >1  KTKTK  'S. 

I .e.-ithin,  ilic  food  of  tin1  nervous  system,  is  a  phosphorescent  fat. 
Then  potash  is  rcijiii.-itr  fur  the  muscles,  ami  red  (Corpuscles  of  the 
blond.  \\liv  theff  .-hould  be  phosphates  juul  potash  in  the  hlood- 
•  •urpuseles  with  chlorides  ami  soda  in  the  plasma  around,  \vedo  not 
vet  kiinw.  Indeed,  this  is  part  of  the  dafkness  undispelled  as  to  the 
hod  v -salts.  "Although  >o  closely  allied  in  t  lit  'ir  eh  finical  pro  pert  ies, 
jiota-h  and  soda  cannot  be  made  to  replace  each  other  in  the  living 
svsteiu.  anil  the  same  is  likewise  true  of  lime  and  magnesia.'' 
(Taw.) 

\Vliatc\cr  the  peculiar  part  plaved  bv  saline  matters  in  the  bodv, 
\\ekno\\  their  importance,  bv  the  consequences  of  beinu'  Without, 
them.  The  phosphates,  the  chlorides,  lime,  soda  and  potash,  are 
e.-seiit  lal  to  iicait  h  and  life. 

"Water,  \\ater  uudenroes  no  change  in  the  bodv.  nevertheless 
it  is  a  most  important  matter.  Solution  is  an  essential  part  of  diges- 
tion. Our  tissues  are  bathed  in  fluid:  our  secretions  How.  If 
hunger  secures  tin1  taking  of  food,  a  still  more  imperative  sensation 
provide.-  for  the  neeessarv  fluids.  Thirst  is  the  security  for  our  sup- 
plying our  tissues  with  a  sufficiency  of  water.  When  cut  oil'  from 
food  and  drink  it  is  thirst  which  drives  the  sutl'erer  delirious,  and 
short  iv  closes  t  he  scene  by  deal  h.  1 1  linger  kills  more  slowly.  Water 
is  even  more  essent  ial  to  life  than  food  itself.  Water  too.  bathes  t  he 
tissues  and  wa-hes  awav  our  waste  and  excrementit  ions  matter. 
The  \  a  sen  la  i1  svsteiu.  like  the  canals  of  \' en  ice.  provide  t  he  fond  and 
take  a\\ay  the  waste  and  otTal.  Water  has,  too.  other  properties  in 
the  In.  iv. 

"\\atcr  docs  not  it. -elf  underLro  any  chemical  alteration,  and 
hence  i-  not  suscept  ible  (»f  liberating  force  -does  not  in  ot  her  words, 
eon-i  lute  a  foree-produeiiijr  airelit .  but  it  contributes  to  chemical 
changes  hv  supplying  u,  necessary  condition  for  its  occurrence  in  ot  her 
Ixxlies."  (1'avv. ) 


(TIAPTKR    III. 
METHODS   OK    IM.'KI'AIMNC   K()()|). 

IN  the  p re  pa  rat  ion  of  food  of  vore.  the  palate  has  no  doubt  been 
the  threat  ^uide.  Still,  a  blind  instinct  set  ins  also  to  have  been  at. 
work.  Tin1  cook  lias  been  led  to  prepare  vegetables  with  meal:  to 
unite  uTain  ami  milk;  to  boil  the  hi^hlv  nitrooviiised  heans  with 
fat  liacon:  or  peas  and  |iork.  Kxperience  at  work  through  count- 
ies-; a '_;•<•>  has  no  doubt  instructed  Man.  alheit  darklv.  what  combina- 
tions  of  food-  arc  ri-'jiiisiir  for  health  under  certain  conditions. 
Sillier-kraut  was  a  \visi-  provision  oi'  ve^cta!»li'  food  during  the  long 
winter,  when  salteil  foods  and  cereals  formed  t  he  chief  dietarv  of  t  he 
people.  A  Lenten  fast  of  vegetables  was  a  useful  liv^ienic.  measure 
for  clearing  awav  the  maladies  incidental  to  such  a  dietarv:  as  useful 
as  vegetables  to  scurvv-stricken  crews  ln-forc  the  davs  of  lime-juice. 
No  wonder  people  Ion0;  a^ro  spoke  of  the  anti-scorbutic  properties  of 
certain  Vegetables. 

r,efoi-c  pi-ocei-din^  with  the  preparation  of  foods,  it  mav  be  we'.I 
to  -i\e  a  Lei  hebv  Table  of  t  he  comparat  ive  value  of  various  edible 
articles  as  tissue-food  and  fuel-food,  without  anv  pledge  as  to  the 
absolute  acciiracv  of  it.  J  t.  is  certainlv  useful,  as  ^'ivini:  a  u'ood 
bi'oad  idea  of  the  value  of  various  comestibles: 


•2}  MAM  AL    OF    I  >l  KTKTK  'S. 

c. \iati  IN.  XITHOCiKN. 

K'ye  M-al W.W>  .*(> 

1'earl   Barley '^.tiO  .1)1 

Barley  Meal >->5.l>:5  .(58 

Treacle.  '-):!.S)5 

Bakers'  Bivad 1D.75  .S8 

skim  ( 'I se 11). 45  4.s:t 

Mult. Hi I'.l.oo  1.*!) 

Beef 18.54  1.84 

Red  llerrin-s 14.:J5  ~M7 

Bull. »ck>'  Liver D.:!4  'J.04 

White  FNi 8.71  1.1)5 

I 'lit  a  toe-, 7.1)!)  .23 

New  Milk 5.11!)  .44 

Carrots 5.08  .14 

Skimmed  Milk 4.:',s  .4:', 

(liven  Vegetables 4. 'JO  .14 

Tunii|» -'.<>:'>  .  U5 

In  eon.-ideriii!_r  the  methods  of  preparing  food,  it    may  be  well   to 
commence  wit  h   Meat. 

Meat.  l!'iHiinj.  One  of  the  most  ordinary  methods  of  cooking 
meat  is  to  boil  it.  Of  old  a  piece  of  meat,  a  ball  of  oatmeal,  and  pos- 
sibly some  ".Teens,  (when  they  are  to  be  got),  were  all  put  into  a  huge 
pot.  which  was  t  hen  heated.  The  old  Border  rule  was.  "  no  brot  h  no 
ball:  no  ball  no  beef."  That  is.  first  came  a  basin  of  broth;  then 
some  of  the  bail:  and  after  that  when  the  ed^v  had  been  taken  oil' 
the  appetite,  the  beef.  If  the  broth  was  not  supped,  there  was  no 
bail:  if  the  ball  was  not  eaten  there  was  no  meat  to  be  looked  for. 
In  those  davs.  when  the  broth  was  of  moment,  the  meat  was  placed 
in  cold  water — about  a  ipiart  to  the  pound  of  meat.  "  Jt  should  be 
covered  with  water  during  the  whole  of  the  process  of  boiling  hut 
not  drowned  in  it — the  less  water,  provided  the  meat  be  covered 
with  ii.  the  more  savonrv  will  be  the  broth."  From  fifteen  to 
t  went  v  m  :nut  e<  for  each  pound  weight  is  t  he  (  Kitchener)  t  ime.  But 
fre~h!\  k  ll"d  meal.  /.<..  while  t  he  riu'or  mort  is  is  on.  'akes  a  longer 
1 1  me  t  ban  meat  which  ha-1  been  kept  !  i  i  1  i  n  cull  narv  phrase  il  is  "  ri  pe. 
M«-at  in.-'1-  (rouirhh  i  about  -I11  per  cent,  of  weight  in  boiling. 

\Vhen  the  ••  liipior."  the  fluid  in  whiidi  meat  has  been  boiled  is 
an  obiei-:  then  the  n icai  must  be  put  in  co id  water  and  all  brought 
to  ;M>'  !  10  ';  but  '  ihe  meat  is  the  lir-1  coii-idi'rat  ion  then  the 
\\aii  r  mu-l  :"'  !io'  "',-•  v  In  n  the  meal  i-  put.  in  it.  "  \\  hen  M  is 
•  '  In  i  •  j  \\  ater,  t  he  a  I  bunion  of  (  he  lies  h  is  i  mined  i- 
;  '  •  '  -.  •  ;  ,  'face  and  to  a  certain  dept  h  inwards,  t  bus 


.MKTHODS    OF    PRKl'AKINC    FOOD. 

forming  a  skin  or  shell,  which  no  longer  permits  the  juice  of  the 
meat  to  flow  out.  nor  the  water  to  penetrate  into  the  mass.  The 
flesh  continues  juicv.  and  as  well  flavoured  as  it  can  po.-.-iblv  become. 
The  irreatcr  part  of  the  savoury  constituents  is  retained  in  the  meat. " 
(Liebiu-. )  Meat  so  prepared  is  very  much  more  toothsome  than 
meat  placed  in  cold  water. 

In  boiling  fish  some  prefer  to  heat  the  water,  and  add  the  ditfer- 
cnt  matters  as  salt  and  vinegar:  then  to  take  the  pan  oil'  the  lire  and 
put  the  fish  into  the  boiling  water  allowing  it  to  remain  in  the 
water  the  same  time  that  is  given  for  boiling  it.  One  gentleman 
who  lias  his  fish  so  "  boiled  "  said  the  plan  worked  up  to  an  hs'b.  sal- 
mon. It  is  asserted  that  the  flesh  is  more  palatable  thiswav  than 
after  ordmarv  boiling. 

lioi'ed  meat  puddings  are  verv  savourv.  The  ordmarv  beefsteak 
and  kidiiev  pudding  is  well  known,  but  the  contents  of  the  paste 
mav  vary:  in  Suffolk  pork  is  substituted  for  beef:  in  Oxfordshire 
liver  and  bacon  are  placed  in  the  paste.  The  best  thing  to  do  with 
an  old  partridge  is  to  let  it  hang  till  it  is  ln^h  and  then  make  a 
boiled  pudding  with  iu  packing  sonic  pieces  of  fat  and  lean  mutton 
around  it. 

<  ii-toin  has  settled  the  choice  of  joints  for  boiling  and  for  roast- 
ing. In  the  case  of  a  ham  it,  is  well  to  leave  the  ham  in  the  fat  till 
the  water  has  ^one  cold;  especiallv  is  this  desirable  where  the  ham 
is  a  drv  one.  \\  hen  dried  fish  is  to  be  boiled  it  is  well  to  steep  it  in 
lime  water  first.  This  conserves  the  phosphoric  acid  as  "bone 
cart  h  "  or  phosphate  of  lime;  otherwise  the  phosphorus  would  be 
lost,  and  with  it  much  of  the  food  value  of  the  li.-h. 

AV/.V////V.      1'robably  this  was  the  earliest  form  of  cooking  meat. 
The  savage   could    put  a  piece   of   meat    on  a  stick    and    have  it    kept 
before  the    lire.       I  Jct'ore  t  he  ila  vs  of    the  "  jack."  do^s  called  "turn- 
spits" were  engaged  to   keep   the  meat  t  urning  before   the  lire.      As 
well  as  turn  Mi".',  basting    is  required  to  keep  the  meat   from  hurnnrj;. 
The    tiiuc    for    roa.-ting    is   a    little   more    than    for  boiling.      On    the 
who,e  roast   meat    is  more;  savoury    than    boiled    men!.       Ifoa-tinu;  ,s  a 
method    of   dealing   with    fresh    meal:    while   salted    meat    is    boiled. 
True  to  his  theory  of  coagulating    the  albumen    of    i  he  mea:    at    th- 
exterior    to  preserve  1  he   juice.    Liebi";   advised    that    th"jo>>.;    '• 
placed    near    the    lire,    and    then    after  the    -urt'are   wa-    hardened,   to 
ulihdraw  it  a  little.      I'suallv  however,  i  he  o!>\  er.-c    -    pra    : 
ha-  t  he  .-auction  of    I  )r.    Kitchener.      "  The  ha-t  inir  on^'h1   • 
forme*     nke  a  religions  dut v.      A  meat  screen  or  rdlcctor  ;•  '.•'. 


L>»'.  MANUAL    OF    IMKTKTK'S. 

as  it  saves  mal  l>v  keeping  both  sides  hot."  The  fat  \vliirh  exudes 
is  saved  as  dripping,  \vlnle  the  meat  juice  is  sent  up  as  gravv.  which 
gives  relish  to  the  vegetables  eaten  with  the  meat.  As  to  whether 
the  meat  should  lie  raw  or  well  done  is  a  matter  upon  whieh  tastes 
dilTer.  When  the  mast  meat  is  destined  to  appear  on  table  in  cold 
form  onlv  it  is  well  to  avoid  cutting  into  it  when  hot.  Liebig's  idea 
of  eondeii<in^  the  juice  in  the  meat  is  correct  enough  in  this  respect. 

lliik'nui.  The  convenience  of  theoveii  is  a  great  toillptatiou  to 
its  use.  It  issa;d  meat  loses  less  weight  iu  baking  t  han  iu  any  other 
cnlinarv  treatment  of  it:  but  what  it  gains  iu  weight  it  loses  in  tla- 
\oiii-.  I  >r.  K  ing  ( 'handlers  savs.  "  \o  kitehen  is  complete  wit  bout 
an  open  range.  Il  is  impossible  to  have  a  properly  roasted  joint  by 
anv  other  means,  as  I  learned  hv  visiting  the  private  premises  of  a 
'  Patent  Kitchener'  maiiufaet urer;  finding  there  an  old  fashioned 
iireplaee  in  full  operation.  He  cared  too  much  for  his  diet  to 
employ  his  uwn  works. " 

An  oven,  of  course,  is  indispensable  to  a  meat  pie.  Meat  pies 
bear  the  reputation  of  liein^  indigestible,  and  probably  they  deserve 
it,  hut  whether  this  is  due  wholly,  or  only  partly  to  the  paste,  and 
meat  so  treated  is  not  itself  indigestible,  is  a  matter  not  yet  deter- 
mined. The  addition  of  eggs  which  get  as  hard  as  leather  mav  he 
sound  practice  from  a  cook's  point  of  view,  but  t  he  physician  and 
physiologist  can  not  be  expected  to  be  in  favour  of  it. 

lii'nili int.  This  is  a  verv  savoury  way  of  treating  a  slice  of  meat, 
lie  i!  a  million  chop.  ;i  lieefsteak.  or  a  veal  cutlet  (which  is  often 
fried  ).  I  >roi  1 ;  nu;  belongs  too  essent  lallv  to  the  cook's  craft  to  he  dis- 
cussed  here. 

/'/•///////.  l-'nr  slices  of  meat,  frying  is  an  abuse  except  for  bacon 
or  ham.  h  i-.  however,  an  admirable  way  of  treating  lish,  though 
it  may  he  ipiest  loiieil  if  a  fried  herring  is  equal  to  one  properly 
broiled  ,„•  hrandered. 

The  jlat  tishe-  are  specially  adapted  for  frying,  and  a  fried  sole  is 
savoury  food.  lint  if  the  cook'-  fat  be  not  suiticielitlv  hot  it  soaks 
ml"  tiie  tibiv  of  the  ti-h  and  few  edibles  are  more  indigestible  than 
a  had  I  v  fried  sole.  With  looser-fibred  tish  this  carelessness  is  less 


the  point  of  \  ie\\   of  :  he  palate  and    digestion. 

/"/.       I'h;-     -  ihe  most    economical  method  of  cook  in^r:    it  is 
especially  adapted  to  hou.-eholds  where  strict  economy  must  be  prac- 


MKTHODS    OF    I'KKI'AIMV;     F<  ><>!>.  L' , 

tisen.  A>  Dr.  Buckmaster  observes,  "  All  ami  cverv  kind  of  iin-a' 
will  do  tV)r  a  stew,"  and  "  All  vegetables  may  In-  cut  int<>  slice-  and 
cooked  in  a  stew,  except  potatoes."  All  gristly  meat  and  trimniiirj 
with  otl'a!.  as  sheep's  trotters  and  pill's  1'eet,  will  do  for  a  .-lev,  ;  of 
course,  as  he  adds.  "  the  better  the  meat,  the  1  tetter  the  stew."  An 
I  nsh  stew  consists  of  unit  ton.  potatoes,  and  onions.  ;ind  un  admirable 
as  \\  ell  as  economical  dish  it  is.  Indeed,  such  compounds  of  m<-at 
and  vegetables  in  a  stcwpan  and  well  moked  would  be  must  accept- 
able to  most  households,  but  are  comparatively  neglected  in  favour 
of  joints.  The  Ion;:  action  of  heat  would  ail'cct  the  staivh-^rains 
favourablv  and  thoroughly  detach  the  muscular  tilirilla-  from  each 
other  and  >o  prepare  the  food  for  the  action  of  the  different  digest  ive 
agents  and  processes.  As  orilmaril v  prepared  a  stew  is  deficient  in 
fat.  But  care  and  knowledge  are  requisite  for  a  trood  stew  and  also 
time.  "Time"  is  what  all  skilled  cooks  hen-  for  in  cooking.  Ha.-te 
in  the  preparation  is  the  ruin  of  stews.  I 'uriosit  v.  too,  isa  drawback: 
the  lid  of  t  he  stewpan  should  never  be  lifted  until  il  has  to  be  taken 
otT.  Then  the  savourv  compound  is  sapid,  fragrant  and  appetising. 
It  is  also  most  digestible  — 


This  wa>  written    loiiir  before  science  came  to   bear  its   testmionv 
to  t  he  truth  contained  therein. 

Son /i. - --  Soup    is  alike   a    means   of  ^ratifviiiLT   the    palate   of   the 
wealthy   gourmand,  and    feeding   the  poor    in    times   of    famine.      A 
lijjdit  soup  is  verv  suitable  food  for  the  sick.      Simplv.  soup  is  an  in- 
fusion of  meat,  flavoured  with  a  little  salt  and  some  condiment.      A: 
the  rich    man's  table,  soup    is  a  very  complex   all'air.      It    consi- 
stock    (the  simple   soup)— gelatine,  which  troes   llnid   on    hcatinir. 
often,  cream  an'l    vegetables  of  all   kinds  and   sorts:   sometime-  ;;   . 
thickened  with  broken    biscuit,  as  is   done  in  the  ('hanncl    Island- 
and  a  verv  nutritions  food  is  soup  so  constituted. 

In  some  cases,  lish  is  the  chief  meat  const  it  iient.      In  ot  her  ca-e-. 
legumes   take    i  he    place   of    meat,  whollv    or    partiv.  e-peciadv    wh 
vegetarian-.       Like  stews,  soups,  looked  at   from  their  food  value,  are 
ttnsat isfactorv  as   bein^   too  poor    in  fat.      \Vlicnevcr  cream    .      i.-c/i, 
the  objection    falls   to    the   M-round.      Soup    precedes  other    food,  and 
ta!<c<  the  \an  in  a  meal,  as  furnishing  material    for  tin-  forma'  on  o 
pistr'c  juice.      A  little  meat-juice  to  furnish  the  pepsin  (an  a.! 
oid    lnp.lv)  and    a    little   dextrine    for    the    lactic    acid.    ; 


IN  MANUAL   OK   DIETETICS. 

stomach  brews  its  own  peptic  solvent,  while  the  viscus  is  filled  and 
the  palate  gratified.  The  French  invariably  take  a  glass  of  wine  after 
the  plate  of  soup,  "/<'  <•<>/<]>  <!'<i/>/'?'x."  Indeed,  many  soups  contain 
some  wine.  Old  cooks  over-season  soups,  which  should  not  be  too 
highly  seasoned — in  order  not  to  deaden  or  dull  the  gustatory  nerve- 
iihrils:  Really,  the  soup  should  just  be  seasoned  sufficiently  to  stim- 
ulate the  palate.  Nor  is  it  good  for  the  lining  of  the  mouth  if  the 
soup  be  served  up  scalding  hot.  On  the  other  hand,  cold  soup  is 
very  unpalatable.  The  meat  of  which  the  stock  is  made,  ought  to 
be  pounded  and  put  through  a  sieve,  in  order  to  restore  the  natural 
eondit ion  and  properties,  and  give  the  meat  infusion  a  true  nutri- 
tive value.  Then  some  broken  biscuit,  or  some  bread-raspings,  or 
boiled  potato  put  through  a  sieve,  should  be  added,  to  supply  the 
farinaceous  element  or  conversion  into  grape  sugar.  In  some  cases, 
line  sago  is  used.  White  soups  made  with  milk,  and  especially  when 
some  cream  is  added,  are  very  nutritive — as  containing  a  distinct 
proportion  of  fat — and  very  palatable. 

/tut'1  Mint — Some  physicians  have  advocated  the  use  of  raw  meat, 
scraped  or  pounded,  in  certain  cases.  The  advantages  of  such  meat 
are  not  obvious  to  the  physiological  physician.  Indeed,  Dr.  .1.  II. 
Bennett  discountenances  such  practice  in  these  words: —  'To  give 
meat  raw.  however  tinelv  chopped,  is  to  forego  all  the  advantages 
gained  by  judicious  cooking,  and  to  force  on  the  digestive  organs 
double  work."  (Nutrition  in  Health  and  Disease.)  Many  of  the 
advocates  of  raw  meat  have  had  to  deal  with  hysterical  women- — a 
class  so  totally  opposed  to  rational  beings  in  every  way.  that  it  is  no 
matter  for  surprise  that  uncooked  meat  agrees  with  them.  The 
habit  of  eating  uncooked  meat  has  subjected  those  who  indulge 
therein  to  trichinosis;  and  other  ento/oa  are  common  in  Kastern 
Knropc,  where  this  objectionable  practice  mainly  obtains.  Meat 
juice  ami  cold  drawn  beef-tea  have  not.  at  least,  this  last,  objection 
to  their  use.  In  milk,  we  find  an  albuminous  body,  which  does  not 
require  cooking,  certainly.  Considering  that  all  proteids  must  be 
converted  into  peptones  before  they  can  pass  from  the  alimentary 
i 'anal  into  the  blood,  any  advantage  to  be  gained  from  raw  meat  juice 
is  quite  hypothetical;  and  involves  a  lack  of  acquaintance  wit h  the 
physiology  of  t  he  digest  ive  act  on  the  part  of  t  hose  who  resi  >rt  to  such 
raw  meat. 

In  the  cooking  of  meat,  there  is  no  clinical  or  even  molecular 
chaii";1'  invoked  in  the  proteid  material.  The  muscular  fibrilla1  are 
loo-en  I'd  by  the  act  ion  of  heat ,  while  the  coagulation  of  the  albumen 


MKTHODS    (iF    I'K'FI'AIM  N<  i    FOOD.  L".» 

renders  the  fibres  morr  brittle.  Conse<p.ientlv.  cooked  incut  i-  in"!-.- 
easily  mast  icated  than  raw  meat.  While  tin-  further  di~inte<_rra' '...n 
of  the  flesh  is  facilitated  by  this  change:  -and  disinte^ra^ou  pre- 
cedes solution  ill  the  digestive  act. 

Starch.  — /J/VY^/  Mnkunj. — Stareli  is  the  cliaracteri-t  ic  cicnieni 
in  bread.  "  the  stall'  of  life."  \\heji  wheat  was  first  brui-ed  in  a 
(jiieni.  a  species  of  mortal',  or  ground  by  the  '•  two  women  sittii,'_r  ;,: 
the  mill,"  all  the  elements  of  the  seed  were  in  the  Hour,  [.on-  } 
fore  chemistrv  could  tell  them  the  follv  of  what  thev  wen-  do;;;^. 
e<ioks,  led  l>y  the  eve.  bewail  to  prefer  white  bread.  In  order  I"  a!- 
tain  this  (Mid  the  miller  devised  means  to  remove  the  external  coat 
of  wheat  as  bran.  I'nfortunatelv  in  this  external  laver  lies  the  bulk 
of  tlie  salts  in  wheat.  l>y  t  his  fateful  gratification  of  the  eve  a  cruel 
wronjjf  was  intlicted  upon  the  youni:  and  ^rowin^  creatures.  An 
erroneous  taste  dies  hard,  and  the  attempts  to  induce  the  proletariat 
to  adopt  whole  meal  bread  have  met  with  little,  verv  little  success  a- 
yet.  Those  who  adopt  whole  meal  bread  have  usuallv  pas^e.l  the 
^rowin^  a^e. 

Flour,  as  now  made,  is  far  inferior  to  that  of  earlier  davs.      The 
destiny  of   Hour  is   the   oven.      Sonic  of    it  mav  iro  another  Li'ate.  Imt 
the  bulk  crocs  to  the  oven.      Mixed  with  water,  a  little  salt  and  vea.-i. 
Hour  is  worked  into  doii^h.  is  set  before  the  (ire  to  rise;  after  whieh 
in  loaves  it  is  placed  in  the  oven   to    be    baked.      Yeast  is  a  1'enuent- 
iiuj  a^'ent    (a  form  of   lowly   plant  lift — yeast    fuiiLTiis).      "  The  pres- 
ence of   veast    in  a  substance   containing  sn^ar,  or   starch,  which    is 
convertible   into    su^ar,    and     nitro^eiiisei]    matter,    induces    certain 
chemical    changes,    comprehended    under   the   term  vinous  alcohol.! 
fermentation.     These  changes  in  tlie  nrakincr  of  bi-cad  consist  in  the 
conversion  of  thesiijiar  of   the   Hour  into  <ilnji<>!  and    <-<ir1><>,i!i-  ^'.v; 
the  lat ter  in  its  dl'orts  to  escape  from  the  dou^rh  in  which  n  is  mi \>'d, 
distends  it.  forming  vesicular  spaces  in  its  interior,  and  so  can-in^  1 
to  become  porous  or  li^ht.       M  ucii  of  the  alcohol  is  dissipated    ;.  ' 
process   of   baking.*       hurin^   the    bakin::,    part,   of   the   stardi    ; 
dotibtedl      is    convertcil    into   dextrine    (A.   Hill    Ilassalh.      This-  ••'.•• 


3d  MAM'AI.    OK    niK.TKTlCS. 

kent  in  the  oven  a  longer  time  without  burning,  the  conversion  of 
the  .-tarch  int"  dextrine  would  be  more  extensive  and  complete. 

From  its  vehicular  or  spongv  condition  bread  is  readiiv  masticated 
and  mixed  with  saliva  in  the  mouth.  For  delicate  children,  in 
whom  the  saliva  is  deficient  in  quantity,  or  in  qualitv,  some  guiding 
principle  led  shrewd  persons  to  use  only  the  crust  of  the  loaf,  which 
contains  more  dextrine  than  the  crumb.  This  was  a  wise  choice. 
Then  came  the  preparation  of  rusks  and  tops-and-hottoms.  Finally 
came  "  baby  foods,"  of  all  kinds,  a  matter  to  he  discussed  further 
on.  The  principle  underlying  all  "  baby  foods  "  is  t  he  conversion  of 
insoluble  starch  into  soluble  matters.  Newly  made  bread  is  a  poison 
to  most  dyspeptics.  It  is  moist  and  readiiv  goes  into  a  lump  in  t  he 
mout  h  :  while  stale  bread  is  drier  and  of  tinner  consistency,  and  does 
not  readily  lose  its  vesicular  character  in  the  mouth.  Hot  breakfast 
rolls  are  toothsome  but  not  digestible. 

The  reason  whv  boiled  paste  is  indigestible  with  manv  persons 
is  that  it  is  not  vesicular,  but  a  solid  mass.  When  flour  has  been 
mixed  with  fat.  as  lard  or  butter,  as  is  done  in  making  pastrv,  the 
starch  and  fat  arc  so  intimately  mixed  and  incorporated  that  the 
saliva  cannot  get  at  the  starch  granules.  Further,  too.  disintegra- 
tion is  not  MI  easily  performed  as  with  bread,  and  between  the  two 
the  stomach  is  handicapped  with  masses  of  unchanged  starch  and 
fat,  upon  neither  of  which  has  it  any  solvent,  action.  No  wonder 
then  that  it  aches! 

As   the  confectioners*  wares  consist    largely  of   Hour  and  far.  well 

kneaded    into  paste,  they  are  shunned    by  the  parents  and  guardians 

of  children  of  tender  years,  from  the  ulterior  consequences  of  eating 

Not  only  do  thc-e  masses  oll'end    the  stomach    but    thev  load 

the  bowe]-;   except   when  1 1  ie  i  r  i  rri  t  a  ii  t  presence  set  s  u  p  d  ia  rrl  10  a  for 

The  inhabitants  of  the  I  nited  States  are  reputed  a  dyspeptic 
race;  and  certainly  a  number  of  representatives  of  the  threat  1,'epub- 
bc  ha  nto  m\  consulting  room.  suiTeriii'^  from 

indige-t  ion.  In  ;  i  ••  ab.-eiiee  of  personal  acquaintance  \\  it  h  the  New 
World  I  an  •  to  rely  upon  what  I  bear,  and  upon  American 

cookery  book-.  In  reading  the  instructions  as  to  the  making  of 
"corn  bread."  I  lind  "ISake  quickly  and  steadily  In  a  buttered 
mon  Ii  i.  i  ,<••  I  usually  sutliee.  "  Th '-  is  not 

loh;_<    for   1      •  111]       II       '  .         Then    it      i-    told      Pie     !  iie.-e 

cake-  1 1  le  t  line    for  t  he  s;di\  a  to  ac|    u  |>ou 

the  ,-tai'ch.      In    the    name  ot    common    sense   ran  \ve  wonder    if   the 


MKTHODS    Ml-'    I'KKl'AKINc;     KMM]>  :',  1 

out  raided  stomadi  sometimes  protests?  1  Iain  pep-d  with  immense 
quantities  of  unehaiiLr»'d  starch  il  cannot,  perform  it-  work  without 
effort.* 

If  corn  bread  up  cakes  were  eaten  slo\viv  initi-h  of  tin-  re-niiant 
dyspepsia  would  IK-  avuiilcil.  The  albumen  of  mai/.e  or  Indian  corn 
is  Hi  it  gluten.  Consequently  it.  will  not  alone  make  bread.  The 
combination  of  inaixc  Hour  with  wheat  ilmir  is  what  i-  required  for 
a  readily  digestible  oread.  All  boiled  paste,  all  boiled  pudding  like 
a  suet  dumplniLT.  or  a  meat  pudding-paste,  ,-hould  consist  of  a  union 
of  the  two  kinds  of  (jour.  'Ail  baked  pudd  in.'j's  sliould  be  made  of  t  he 
two.  espeeiallv  when  ep^s  are  used.  \\liea!  Hour  and  eii'i:-  form  a 
compound  not  easily  disintegrated,  however  palatable.  Certainly 
paste  should  contain  the  largest  ]ira'-t  ieal>le  proponion  of  mai/.e 
(lour.  If  the  medical  profession  were  only  ^enerailv  familiar  with 
the  properties  of  gluten  they  couid  L;'IVC  a  dii'ection  to  the  d.etarv  of 
the  Jiurserv  of  a  desirable  kind. 

In  the  Xorth  of  Kn^laiul  eakes  of  all  kinds  ai'e  in  vo^ue,  and  the 
frying-pan  and  tlu' "  girdle."  or  ni'i'idle  is  in  constant  request  as  well 
as  the  oven.  One  form  of  cake  is  disappearing.  \\  hen  an  audition 
was  made  to  the  family  <rrmip,  a  cake  was  prepan-d  bv  adding  pientv 
of  butter  to  some  ilmir.  throwing  in  a  few  currant-,  rodini:'  the 
paste  about  a  quarter  of  an  inch  stick,  and  piae'm^  this  in  the  frvin^- 
pan  if  the  oven  was  not  available.  While  eookinu  ;'  u'-~  d:\idcd 
into  s(jiiares,  alioiit  the  si/.e  of  the  palm  of  the  hand.  \\  hen  cooked 
it  was  still  a  -oddeti  mass,  but  toothsome.  The  little  .-qua res  were 
then  split  and  but  ter  addeil  free!  v  to  t  he  warm  cake.  Old-fashioned 
doctor-  liked  this  cake,  and  drank  it  down  with  tea  (said  to  have 
been  "  laced  "  with  rum)  to  prepare  them  for  the  journev  home.  It 
is  living  out.  probably  because  the  le-s  potent  digestive  orpin-  of  t  he 
present  generation  cannot  deal  with  it.  Paste  roded  out  th;n  in  a 
circie,  with  jam  or  fruit  laid  ove.rone  half,  while  the  other  ha.f  is 

folded  over,  and  the  eil^es  do-civ  pinched  together,  la  a  eollimon 
cake,  or  pastry  in  the  North.  Then  there  are  Kcdes  cake-,  and 
I>anbury  cakes,  comliinations  of  Hour,  fa; .  cm- rant-  and  eandied  peel. 
The  early  emigrants  to  \ew  Mndatid  took  their  taste  for  cake-  o\<-r 
witli  tln-tii:  and  .-undi'v  rolling-pins  were  in  the  hol.i  of  the  "  Mav 
!•  lower."  we  mav  depend  upon  it.  The  bane  of  all  t  he.-e  eoiiie-t 
is  their  mdiirestibilit  v  on  account  of  the:;-  form1.  n(_r  soiid  ma--'  :M 


MAM'AI.    (>K    IMKTKTK'S. 


cakes  arc  tempting  to  the  palate,  especially  in  early  years.  A  story 
is  (old  of  a  little  <jr\\-\  who  wanted  more  cake.  "  She  was  told  if  she 
ate  any  more  she  would  be  ill,  and  the  doctor  must  be  sent  for." 
This  effective  deterrenl  on  all  ordinary  occasions  failed  in  this  emer- 
gency—  ",lu-:t  ano//.cr  piece,  and  then  send  for  the  doctor,"  she 
pleaded.  Fat  -'ind  Hour  sweetened  form  a  good  food  from  a  chemical 
point  of  view,  hut  the  resultant  product  is  unfortunately  not  diges- 
tible; noj-  are  flour  and  eggs  as  in  sponge  cakes  much  better.  The 
addition  u|  mai/.e  Hour  to  wheat  flour  gets  rid  of  some  of  the  difli- 
cultie.-  of  pa.-trv:  but  not  of  all  of  them. 

Starc'i  of  various  kinds  is  in  use  for  milk-puddings.  For  chil- 
dren, invalids,  and  dvspeptics  such  milk-puddings  are  admirable, 
unfortunately  dyspeptics  usually  abhor  them;  a  milk-pudding  is 
usuaiiv  allowed  an  hour  in  the  oven  so  that  the  time  for  the  action 
of  heat  upon  the  starch  allowed  is  double  that  of  cakes.  The  com- 
bination of  >tarch  and  milk  is  capital  food.  Unfortunately  the  cook' 
will  add  eggs,  which  increases  the  food  value  doubtless,  but  detracts 
considerably  from  the  digestibility.  The  addition  of  butter  is  good. 
If  the  various  forms  of  starch,  as  sago,  rice,  tapioca,  etc..  were  sub- 
jected to  heat  before  being  added  to  the  milk  the  conversion  of 
starch  would  lie  great  lv  facilitated.  Act  ing  on  this  principle.  I  have 
taught  mv  cook  to  put  the  farinaceous  matter  in  a  little  pie  dish  in 
the  oven.  drv.  and  bake  it  for  an  hour  or  two,  taking  care  not  to 
scorch  it  by  having  the  oven  too  hot.  This  docs  not  impair  either 
sightliness  or  the  flavour  of  the  starchy  matter.  The  conversion  of 
starch  is  pn>\ed  both  by  the  iodine  test,  and  bv  artificial  digestion 
cit  her  wit  h  malt  or  a  malt-extract.  The  most  perfectly  digestible 
milk-pudding  is  made  bv  adding  some  ground  malt  to  the  baked 
starch,  when  the  warm  milk  is  poured  on,  and  stirring  the  whole 
tnget  her.  aft  er  that  set  t  ing  it  in  a  warm  place  for  ten  minutes  before 
putt ,  tig  in  t  he  oven.  The  diastase  of  t  he  malt  ads  upon  the  cracked 
and  changed  starch  granules,  and  the  resultant  product  is  lit  for  the 
weake-i  liahv.  invalid,  or  dyspeptic.  Indeed,  ground  malt  is  a  much 
bet  ter  a<  id  it  ion  than  cane  sugar  wherever  such  sweet  milk  puddings 
turn  ac  d  in  a  fastidious  .-tomach.  (Tin-re  is  however  one  point  on 
whieh  the  conk  mii-t  be  put  upon  her  guard,  i.e.,  not  to  add  any 
ordinary  -ugar  to  a  pudding  containing  malt.  It  is  sweet  enough 
with  the  inalto-  .  Fspeciallv  is  this  caution  to  he  observed  in 

t  IIOM- ease-  \\  he|-r  ordinary  milk-puddings  sweetened  with  sugar  turn 
-our  in  tin-  stomach.  )  Indeed,  ground  malt  alone  wit  h  a  little  milk 
makes  a  very  n'cc  pudding,  and  is  improved  by  an  egg. 


MKTHOPS    OF    I'KFI'AKIM;     Fool)  •••> 

The  principle  of  employing  farinaceous  matter  which  ha-  a.rcadv 
lieen  subjected  to  heat  (so  that  a  considerable  conversion  of  stan-h 
has  ^ouc  on  before  the  human  salivary  diastase  comes  into  play),  is 
carried  out  in  practice  in  the  form  of  bread  and  butter  pudding. 
Slices  of  stale  bread  buttered  are  placed  in  a  dish,  some  currants  arc 
thrown  in,  and  then  some  sweetened  milk  poured  over  all:  and  the 
dish  is  placed  in  the  oven:  or  bread  is  crumbed  and  milk  added; 
but  t  his  pudding  lacks  t  he  fat  of  t  he  lir.-t  form.  ( >r  a  milk-pudding 
can  be  made  of  broken  captain's-biscuit  (which  is  baked  at  a  hiirh 
t  em  pe  rat  ure).  The  substitution  of  malt  for  cane  su^ar.  as  described 
above,  is  all  that  is  required  for  an  ideally  digestible  dish  for  delicate 
stomachs;  the  flavour  of  maltose  beinir  also  finer  than  that  of  cane 
su^ar. 

When  milk  puddings  are  served  at  table  as  a  rule  they  lack  fat. 
If  hot  it  is  well  to  place  a  knob  of  butter  in  the  middle  of  the  mass 
of  pudding  on  each  plate;  it  will  melt  before  the  pudding  is  cool 
enough  to  eat.  and  mi  \es  readily.  Very  fastidious  personages  would 
perhaps  sav  that  such  a  practice  is  "  messv,"  and  object  to  "  mak- 
ing mortar,"  but  these  objections  do  not  outweigh  the  real  value  of 
the  addition  of  the  butter.  If  cold,  like  creeled  rice,  it  is  well  to 
eat  butter  and  su^ar,  rather  than  su^ar  alone,  to  the  cooked 
farina. 

'/'In1  I'nlttfn. — The  potato  lies  midwav  betwixt  starch   and  vegeta- 
bles.     It  is  a  vegetable  neb    in    standi:  and    boiled    potatoes    ma-lied 
have  been  used  as  an  adulterant    -well,  hardlv  that  —  to  Hour  in  pre- 
paring dottu'h  for  bread.      The  object  of  cooking  a  potato  is  to  trans- 
form it  from  a  firm  indigestible  vegetable  into  a  ball  of  Hour.      About 
the   cooking  of  a    potato  opinions  ditTcr.      Some    hod.    some   .-team. 
some  pour  oil'  the  first  water;  some  pour  otf  the  water  when    boiling 
is  completed,  and  leave   the    potatoes   a    little   time    m  the  pan.       l>e- 
fore  the    potato   disease    in    the  Irish    famine  of    lS4i!.   potal-ies    were 
commotilv  boiled  hi  their  "  jackets,"  or  skins.      \\'hen    boiled  i;    was 
enough  to  take  the  potato    in  both  hands,  and  with  a  ifeiitle  pud   oil' 
came  each  half  of  the  peel,  and  the  llourv  ball  dropped  into  the  1 1  :~h. 
llard    potato    is   utterlv  indigestible,  and    potatoes  cannot,  like  other 
vegetables,  be    used,    to  stew  with    meat.       Ma. -I  led    potato  i-  in;-' 
tioiiable.      The  cooked    potato  is  beaten    up   and    mixed  with    cream, 
or  hot   hutteraiid  milk,  until  a  ii^ht  white  product    i-  o'ota.n 
is  mo-t   palatable  if  well   made:   as  such  it  can    be  eaten  ;o  m<  • 
mashed    potatoes   and    sausage   are    familiar  in    all    (own-,  a- 
hou-c    luiiche-:   or   a    wall    of    ma-hed    potatoes     -    made    foi 


:'.  I  MANTAI,    Ol-1    DIKTKTICS. 

meat,  or  ;i  cot tau'e  pic.  Ma.-hed  potato  with  salt  ami  pepper  Jllld  set 
before  tlic  lire  to  tii-o\vn.  \vilh  a  ^-ia.-s  of  milk.  forms  an  ideal  lunch- 
eon, according  to  !\m^  Chambers.  Tin-  introduction  of  tin-  potato 
revolutionised  the  fare  of  Kurope  in  winter.  Saner  kraut  the(ier- 
nians  had:  and  pickled  gherkins  were  common  over  the  most  of 
Mu rope,  and  in  Southern  climes  some  greens  were  possiMe;  onions 
too  1 1  iev  had  :  hut,  after  all,  their  winter  dietary  was  deficient  in  ve^- 
etahle  fond,  and  eolise'  jilelit  1 V  Scurw,  and  other  scorbutic  alTections, 
were  rii'e.  The  monks  cultivated  the  wild  ejirrot  and  turnipas  lux- 
uries: hut  these  were  only  for  the  well-to-do.  The  potato,  which 
keeps  well  with  a  little  care,  at  once  supplied  the  desired  vejjfetahlo 
food,  and  the  winter  fare  of  man  was  no  longer  without,  the  desir- 
able element-. 

I  •  /I /.////<  x. — The  vegetables  in  common  use  are  mot  sand  irreens, 
while  celery  is  a  stem  like  rhubarb.  In  roots  as  the  turnip,  carrot, 
parsnip^,  beet,  mangel- wur/.el.  also  the  onion,  etc..  there  are  ijtianti- 
t  ics  of  starch  and  su^ar.  while  m  greens  the  leaves  consist  of  vege- 
table pareiichvina  of  low  food  \aluc  but  mostlv  rich  in  salts.  The 
most  common  art-  cabbage,  cauliflowers,  broccoli,  Brussels-sprouts, 
spinach,  lettuce,  endive,  salsifv.  and  other-.  (  Vierv  is  an  excellent, 

esculent     f 1.       In    speaking   of    the    value   of   alkalies    in   our    food 

and  especially  phosphates.  Liebiv;  savs  "  The  sure  Li'iiide  of  man  and 
animals  has  taught  us  how  to  counteract  the  deticienev  of  veal,  lish 
and  eiTLTs.  in  alkalies  bv  the  addition  of  vegetables,  potatoes,  or  salad. 
Kit'-hcu  vegetable-,  m  tins  point  of  view,  till  up  manv  lilanks.  The 

I  1 

(plant  it  les  of  salts  of  alkalies  and  alkaline  eart hs.  contained  in  manv 
of  these,  excites  astonishment.  ( 'elerv  contains  from  1'i  to  -jo  per 
< -i -n t. ,  common  salad  '!'•'>  to  -.'  (  per  cent. ,  and  cabbage-heads  (l)iids)  in 
per  cent. .  of  t  he  weight  of  t  he  drv  plant  in  the  form  of  incombustible 
salt-."  Of  the  value,  then,  of  vegetables,  there  can  be  no  doubt: 
nor  of  the  -ure-foo|  d  n  line)  which  led  man  in  the  davs  of  voiv  to 
boil  vegetables  in  th«'  pot  with  hi- animal  matter.  Tin- enicifera-, 
especiallv  cabbage.  howe\er,  do  not  -'o  into  this  pot.  but  into  one 
of  t  heir  own  on  account  of  t  he  oH'eti-i  v  e  ,-meil  "  '^reen- water  "  pos- 

'I'he  cookiu'_r  of  v  c^-etatile-  i-a  •_"-,  n'    art:    more  <-<peciallv  greens. 
'  'I'hev  are  !ie-t ."  .-a  v-  I  )r.  \\  '  <-]\  in  full  -eaxui :  "  "u  n  ripe 

v  e^etable-;  are  a  I  a  nd  u  n  \\  ho,e-ome  a-=  linn  pe  fruit .  "      "  I-'resh 

Lfathered  i-  the  motto  tor  vegetable  product-.  An  orange  or  a 
banana  in  London  -r  \<  \\  York  a  diU'en-ni  tiling  from  the  -anie 
fruit  j  lip-kdl  •  tree.  l.'ooi  .  ureen- and  salads,  are  :  he. 


MKTHODS    <>K    I'RKl'AIMN'i;    Fool). 

same.  Potatoes  should  be  du^  out  of  tin-  ground  the  la-t  po--i 
llionietlt  before  cooking,  to  '!"  justice  to  tliein.  With  roots  all.  1 
greens  when  stale  it  is  well  to  put  them  into  eoid  water,  whi<  h  will 
freshen  them  ii|>  a  little.  Vegetable  matters  arc  sueeiiient  and  !"-'• 
water  rapidlv,  wlneli  impairs  them  in  everv  wav.  Thev  shoni  1  he 
plunged  iii  the  pot  when  the  water  is  hoiim^.  They  are  a  tiek'i.-h 
atl'air  to  cook.  "  Raw  "  vegetables  are  unpalatable;  while  if  "  ve-j-i- 
taliles  are  a  minute  or  two  too  lon^  over  the  tire,  they  lose  all  their 
heautv  and  flavour."  Fresh  vegetables  require  considerably  !••>- 
time  for  sutlieieiit  oookinir  than  do  stale  vegetables.  The  advan- 
tage of  life-  in  the  country  is  uTeat  in  the  matter  of  vegetables.  If 
taken  fresh,  thev.  however.  pr<'serve  well  in  tins. 

After  bein<r  carefullv  picked,  greens  should  be  washed  in  .-old 
water  and  then  drained,  after  that  boiled  \\-Jth  a  little  salt:  when 
cooked  thev  should  lie  drained  we]]  and  served  hot. 

Cabbages,  as  eaten  in  London,  are  an  abomination.  Thev  should 
be  treated  as  in  <  Icrmanv  and  the  I'nited  Slates.  When  boiled, 
''drain  well,  chop  am!  stir  in  a  tablespoon  fill  of  butter.  w:t  h  pepper 
and  salt."  Such  cabbaire  is  also  ^ood  cold:  and  heated  up  next  dav 
it  is  excellent.  Like  soup,  cabbage  is  better  the  second  dav  than 
the  tirst.  lint  served  as  thev  are  in  the  South  of  Knidatid  thev  are 
a  very  pool-  alTair. 

In  the  North  of  England,  in  earlv  spring,  it  is  customary  to 
pit  her  the  leaves  of  a  wild  let  t  uee  with  the  vouti^  shoots  of  tin-  com- 
mon net t le  and  ehop  them  tine,  then  to  mix  some  pearl  barlev  \\  . t  h 
them  and  boil  in  a  bair.  This  is  called  a  "  herb  pudd  :nir  "  and  it  was 
no  doubt  a  valuable  food  in  old  dav-  for  scorbutic  all'ections.  Tho 
''  nettle"  beer  of  t  lie  M  id  iaiid<  no  limibt  had  a  claim  \»  be  regard'  - 1 
as  anti-scorbutic.  e<pcciallv  when  hoarhound  was  added. 

^nliiils.  —  I'licooked    vcLTctaliles  are   usuallv  eaten    as   salad.      The 
lettuee.    the   endive,  the   dandelion,    mustard,    cress,  aii'i    \\  ate:-.-)1'  -~ 
alone  or  mixed,  are  the  mam  constituents  of  salad.      ( 'iietimbcr  at.' 
onion    form  a  savourv   salad.       I'otalo    salad    i-    r. ot    mu'-h    ;n    n-e    .M 
Ln'j-land.      Some  like  a  little  sorrel  in  t  heir  salad-:  oilier-  piv  :'••:• 
tomatoes.      (  'eierv.   radi-hes  and  watei-ri'e--  are  as  often  a~ 
alone.      Some  person-  prefer  to  dre-s  then1  salad    on    ti:-1  i'!a*'-.   " 
other-  prefer  it  dressed  before  it  eomes  to  labie.       A-  to  ;ii. 
the   old    Spanish    proverb    ran    to    th;s   ell'e'-t.    "To    mal\i'   . 
salad  there  should    be  a  miser    f"r   oil.  a    -pcndt  drift    :'<•:•    ' 
wise  man    for   salt .  and  a  madcap  to  st  ir  and  mix   a! i    to-.  •  :  .  • .         1  • 
irat  herini:    salaii.     no   steel    knife    should     lie    u-cd.       A:':- 


;}«>  MANTAI.    (»K    IMKTKTICS. 

picking  ami  wash  i  71^  t  hem,  "let  tin -in  remain  a  while  in  the  eolander 

t<>  drain;  lastlv.  swinir  them  Mvntlv  in  a  dean  napkin."  then  place 
tin-in  in  tin-  salad  dish  and  prepare  tin-  dressing,  and  "  pour  it  down 
the  side  of  the  salad  dish — and  don't  stir  H  up  till  tin-  mouths  are 
readv  for  it.''  So  savs  I  >r.  Kitchener,  who  adds  -"  \\'e  recoinnieiid 
the  eaters  to  bo  niiiidl'ul  of  the  dutv  of  mast  icat  ion  without  the 
due  performance  of  which  all  undressed  vegetables  are  t  roiililesome 
eoiiipanv  for  the  principal  viscera,  and  some  are  even  danireroiislv 
indigestible. "  IJeetroot  boiled  in  slices  is  coiniuoiilv  added  and 
makes  t  lie  dish  look  well.  'I  hen  cold  meat  is  often  added.  The 
Italians  used  cold  chicken:  the  hutch,  eold  boiled  turbot  or  lobster, 
and  in  spring,  voting  onions. 

As  to  salad  dressing,  it  can  be  bought,  but  it  is  well  to  make  it, 
when  and  as  wanted. 

The  following  is  Svdnev  Smith's  recipe  for  it. 

••  Two  boiled  polatoi-s  strained  thi-oim'h  a  kitchen  sieve, 
Softness  and  smoothness  In  th<-  salad  u'ive: 
( )f  mordant   mustard  take  a  single  spoon — 
Distrust  tin-  condiment  that  bites  too  soon; 
Yet  deem  it  not,  tlioii  man  of  taMe.  a  fault, 
To  add  a  double  <|iianii1v  of  salt. 
Pour  times  tin-  spoon  \\ith  oil  of  Lucca  crown, 
And  twice  \\itb  vinegar  procured  from  town. 
True  taste  requires  it.  and  your  poet  be^-s 
The  i  io  nnt  led  ye|  low  of  t  wo  bard-boil  I'd  i-!_;-i;'s. 
Let  onion's  atoms  lnrl<  within  lln-  bowl 
A nd  scarce  suspect e(l  animate  the  \\  bole; 
And  laMlv  in  the  llavon-d  compound  toss 
A   m a L;' ic  S|M  u  MI  I  u  I  ol  and  10 vv  sauce!  " 

It  will  In-  seen  that  he  is  not  at  one  with  the  Spanish  proverb  as 
to  tin-  proportions  of  oil  and  vinegar.  He  makes  no  mention  of 
suirar.  which  is  indispensable  in  a  salad  m  which  there  is  sorrel. 
Then  the  I-Yeii'di  have'verv  compound  salads,  and  add  black  pepper, 
eliervi!.  and  .-otiictimes  a  scrap  of  cheese.  Kven  the  dissolving  tin- 
salt  in  tin-  oil  rai  her  t  ban  t  In-  vim-yiir  is  insisted  upon  bv  some  ^'our- 
inands.  There  can  be  no  doubt  that  the  addition  of  a  few  drops  of 
Worcester  Sauce  is  c_,-Mod.  ( 'aniiinat  i\es  arc  ilesinible  in  salads,  for 
vegetables  an-  "  u  ind  \. "  It  is  needie-s  to  sav  that  salads  an-  un- 
suitable for  dvspeptie.-  and  those  \\lio  possess  tender  bowels. 

As  a  wholesome  article  of  diet,  salad-  arc  too  much  necjfleeted  in 
maiiv  hoiischoiii-.  where  thev  mi'j-ht  be  atiopted  \\ith  advantage. 

Fruit.  -  -  l-'ru  it  -  an-  par;  of  i  h"  food  of  man.  and    in  some  areas  a 


MKTIloKS    (IF    1'KF.l'AlilM  ;    FOOD.  :;7 

vcrv  lai'LTe  factor  in  the  dietary.  Thev  are  verv  wliolesome.  though 
in  some  country  districts,  fruit  is  regarded  a-  unwliolesome  and  tend- 
ing to  set  up  diarrhoea.  Certainlv.  if  a  child  is  debarred  from  access 
to  fruit,  it  will  take  the  earliest  opportunity  of  Lror:_rin'_r  itself  on  anv 
fruit  which  presents  itself:  and  not  be  very  particular  or  select  about 
the  (piality  either.  If  the  fruit  be  unwholesome  —either  unripe  <>r 
over- ripe,  the  best  t  hitiLT  that  can  happen  is  for  the  aliment  a  rv  canal 
to  Lfct  rid  of  it  as  (puck  1  v  as  possible.  lint  sound,  ripe  I'm  it  is  w hole- 
son  ie  and  u'ood :  and  if  it  formed  a  part  of  everv  meal,  child  re  n  would 
he  pretty  safe  against  indul^inir  in  indilTerent  fruit.  Cotton  Mather 
said:  "  houbtless  (iod  could  make  a  better  fruit  than  a  strawberrv. 
but  doubtless  he  had  not."  Others  mi^'ht  prefer  a  jargonelle  pear, 
or  a  muscat  irrapc,  or  a  manioc,  while  others  would  prefer  the 
oral i ire.  All  fruits  contain  levulose  suuar,  and  usuallv  some  acid  in 
variei)  proportions,  ranu'in<r  from  the  pineapple  to  the  lime.  Thev 
:ill  contain  alkaline  salts,  which  are  ^-ood  for  the  blood.  "  This  iu- 
lluciiec  of  the  alkalies  is  ,-hown  in  a  decisive  manner,  in  theetfects 
produced  on  the  salts  of  organic  acid  in  the  circulation.  It  has  lon«r 
lieen  observed  that,  after  eat  nil!"  jnicv  fruits,  cherries,  st  rawbei'ries, 
apples,  etc.,  the  nrine  becomes  alkaline.  All  thc-e  fruits,  as  well 
as  the  juice  of  edible  rout-,  tubers,  and  u'i'een  ve^-eta-Wcs.  contain 
these  alkalies  in  the  form  of  .-ait-  of  the  organic  acid--';  n.-nailv  as 
malates  (all  kernel- fruits,  pineapple:)  ct t  rates,  (stone-fruits,  currants, 
potatoes;)  tartrates  (grapes)."  (  Liebi--. ) 

The  utilit  v  of  such  fruits  in  the  iii'ic  acid  diathesis  is  apparent 
and  olivioiis.  If  iroiuv  persons  would  learn  to  cat  iVuit  and  teach 
their  children  t"  follow  the  example  set.  it  would  save  much  re-nrt 
to  medicine  in  later  davs  that  ini^ht  well  be  a\oided. 

The  Lrrowt  h  and  decay  of  fruit  is  t  h us  described  b\   I'aw:      "  I  >ur 
MILT  its  progress,  it   increases  more  or  less  ra  pid  1  v  in  hu ;  k.  and   weight : 
and  as  it  approaches  mat  urn  v  it  lo.-es  its  UTCCII  color,  bee' »mes  bro\\  n, 
vellow.  or  red.  and  no  longer  acts  on    the  air    lii\e  the  |ea\c-,   ;>ut  on 
the  coiitrarv.  absoi'bs  oxv^en  and    ^i\e-  nil'  carbonic  acid.      A-  tin- 
process  advances,  some  of   the  proximate  principles  contained   ;n  the 
unripe    fruit,    part  ictilarl  v    the    vegetable   acids   and    tannin,  .n    !>art 
di.-appear      apparently    liv  oxnlat  ion.  and.  ihn-    ;i    becomi1-   -nnrand 
ast  r  indent .       At   t  he  same  t  i  inc.  t  lie  stare  h   uiu  ler^i  ics  t  ran -for  ma'  ion 
into  -uu'ar:  and    the   insoluble  pectose  into  pectin,  ain;  otlicr  - 
substances  of  allied  com po- it  ion  and    ha\  in-^  npM-e  «r 
timms  character.      The  fruit   in  ihi-  ua\  arm 
tion    for   eating.      Oxidation,    [mwevei-.  still    aiivaiic.-,  :n. 


MAM   AI.    (  >F    IMKTKTICS. 

suj;sir  and  remaining  acid  become  destroyed,  pivin";  rise  to  the  loss 
of  llavour  which  occurs  after  the  full  ripened  state  lias  been  attained, 
and  deterioration  has  set  in."  l-Yoni  this  \ve  can  readily  understand 
whv  unripe  fruit,  as  well  as  over-ripe  fruit,  is  not  wholesome  and 
sahilarv.  "  'I' he  vegetable  acids  and  the  pect in  disappear  in  the  bod v 
sjieedilv  after  heinir  eaten:  while  the  alkaline  base  appears  in  the 
urine  as  a  carbonate:"  though  if  uric  acid  be  present,  as  a  uratc. 

Some  fruits  are  preserved  hv  drvinv;  them,  like  the  ti^,  raisin  and 
currant:  while  others  art1  preserved  hv  boiling  them  with  cane  su^ar. 
as  iruava  jellv.  strawberry  jam,  etc..  while  in  the  South  of  I-'ram-e, 
candied  fruits  are  a  Inrire  article  of  manufacture.  The  addition  of 
the  cane  suirar  in  the  two  latter  cases,  "jives  such  fruit  a  tendencv  to 
turn  acid  in  the  stomach.  Of  old,  fruits  were  bottled,  and  now  they 
are  tinned  extensivelv:  and  when  so  preserved,  keep  perfect lv 
"_•( ioil  for  years. 

At  one  time,  preserving  \vas  a  household  all'air.  and  preserves 
were  home-made.  Now.  preserving  is  51  business.  The  introduction 
of  apple  and  turnip  into  marmalade,  sent  the  best  linns  to  Spain  for 
their  manufactories.  Then  raspberry  jam  was  adulterated  with  the 
pulp  of  gooseberries.  I  >ricd  tip's,  of  indifferent  ipiality.  with  their 
seed,  otTcrAcat  temptation  to  the  rascallv  manufacturer;  and  when 
mixed  with  plum-  that  have  seen  their  best  dav.  and  boiled  with  a 
cheap  glucose  (made  bv  boiling  starch  with  sulphuric,  acid),  and  tin- 
allv  llavoured  with  various  essefices.  the  resulted  product  is  sold  as 
"  Family  .lam. "  Sii'di  preserves  Jive  used  for  jam  puddings,  and  are 
eaten  on  bread.  Thcv  have  a  food  value  of  their  own:  but  are  far 
inferior  to  butter,  for  which  tliev  are  too  coinmonlv  substituted. 

\\  hen  siiLfar  is  boiled  with  butter,  the  well-known  toH'ee  (a  verv 
excellent.  livilro-carl»on),  is  furnished.  Tlie  old-fashioned  plan  of 
mak;n'_r  toH'ee  extensivelv  in  cold  weather  had  much  to  be  said  for 
it.  Jt  supplied  an  extra  ration  in  fact,  of  admirable  and  concen- 
trated fuel-food,  to  meet  the  external  cold:  while  it  also  supplied 
fat  for  healthy  tissue-LTowt  h.  When  delicate  children  object  to  fat, 
and  their  stomachs  \\iil  not  tolerate  cod-liver  oil.  it  is  no  bad  prac- 
tice to  encourage  t  hem  to  take  toffee.  ( )f  course,  the  mot  her  smiles 
deri-iV'lv  at.  the  idea:  but  the  results  arc  often  verv  sat  isfactorv. 
And  such  union  of  carbo-hvdratcs  and  fat  mipht  often  be  utili/ed 
with  advantage  with  d'-lieatc  eliildren. 

Such  then,  are  the  various  forms  of  food  in  common  use  with 
man,  and  their  niethod-of  preparation.  Their  food-value  and  their 
digest  ibilii  v  vary  widclv  not  onlv  in  the  material  it-eif,  but  also  in 
t  he  met  hods  of  prepara' 


CTIAI'TKK    IV. 

COXDIMKXTS.      SAl'CKS. 

Condiments. — Condiments  can  he  regarded  from  two  distinct 
and  different  points  of  view,  vi/.:  one.  hygienic,  and  the  other  ^as- 
tronomic. Salt  is  an  excellent  addition  to  our  food,  and  in  .-ome 
parts  of  the  world  -where  it  is  scarce,  as  in  ( 'cut  ral  A  frica.  tin-  saving 

for   a    rich    man    is—"  lie    eats   salt,  with    his    f 1."      Animals   will 

often  go  long  journeys  in  search  of  salt:  and  the  ImlTalo  mad"  peri- 
odic excursions  to  the  '' salt -licks."  Man  is  rarely  depn\ed  of 
salt:  hut  animals  frcHiieiit  I  v  are  from  ignorance  or  neglect  of  the 
suhjcct.  I  have  read  somewhere  (though  I  cannot  lav  mv  hand 
upon  the  statement),  that  the  hamster  which  lavs  np  larire  stores  of 
provisions  for  winter,  gat  hers  amongst  the  rest  some  leaves  of  the 
gentian  and  the  century,  to  ^-i\c  flavour  to  its  food;  the  hitters  no 
doubt  acting  upon  the  appetite.  Certain  agents,  as  carminat  i\cs. 
have  a  good  effect  as  reducing  flatulence,  and  in  India  some  hirds 
arc  said  to  pick  fruits  and  seeds  containing  aromatic  oils  to  meet. 
some  craving:  just  as  the  Hindoo  adds  curry  to  his  rice.  When  t  ju- 
diciary consists  largely  of  vegetables,  carmi  nat  i\cs  are  specially 
indicated,  particularly  pepper.  And  \  e^vtanans  find  that  carmina- 
tives are  essential,  as  1  >r.  Kitchener  savs,  to  comfort. 

Mustard  is  mainly  eaten  with  meat:  except,  when  added  to  a 
salad.  1'epper,  the  Romans  valued  so  highly  that  they  exchanged 
gold  for  it,  weight  for  Weight.  Indeed  so  much  pepper  formed  part 
of  the  ransom  of  Rome  when  besieged  hv  Alaric.  Cayenne  pepper  is 
st  ill  more  potent  and  pungent .  and  has  to  he  used  sparingly.  Of  oid 
it  was  common  for  persons  suffering  from  flatulence,  to  make  htt.c 
pills  of  Cayenne  pcpperand  bread  crumbs,  and  swadou  them  at  tab'.e. 
(linger  is  anot her  excellent  condiment,  either  added  to  a  pm;.;;  ILT. 
or  eaten  in  powder  as  is  cii.-tonia  rv  \\ilh  melon.  K-~ent;a;  "..-  have 
the  same  elTect  m  relieving  flatulence. 

The  riu'ht,  use  of  condiments  and  then-  true  proportion  ami 
lunation   has  formed  a  -'real    part   of    the  cook's  art   at    aii    Mm  - 
formed    what    is   called    a    "  rcii.-h."  and    the    pauper    \\ 


I"  M  AM'AI.    OF    DIK'I'KTICS. 

eating  a  red  herring  with  his  frugal  meal  of  potatoes — u  to  give  them 

a  relish."     So  an  anchovy  is  added  to  a  beefsteak. 


And  the  condiments  should  tie  added  in  the  act  of  cooking.  If 
pepper  he  wanting  in  a  beefsteak-pie  or  pudding,  to  add  it  after 
serving  is  a  poor  substitute  for  the  real  article.  Some  persons  prefer 
hiirhlv  seasoned  dishes;  and  as  a  broad  rule  it  niav  be  said  the  taste 
for  condiments  irrowswith  years.  Children  rarely  euro  for  highly 
seasoned  dishes.  Al-o  as  the  palate  flags,  eond iinents  and  sauces  an; 
more  in  request :  and  tins  is  specially  true  of  gourmands  in  hot  cli- 
mates. The  eurrv  of  the  Kast  Indies  finds  its  correlative  ill  "the 
pepper  pot  "  of  the  \\'est  Indies.  Paw  says  of  them — ''Through 
their  aromatic  and  pungent  qualities  they  also  assist  digestion:  tin; 
//ii'i/ii*  i'/n  n/inli  being  by  promoting  the  flow  of  secretion  and  in- 
erea-Mii;'  the  muscular  actiyifyof  the  alimentary  canal.  In  some 
cases  they  may  lie  further  useful  by  serving  to  correct  injurious 
properties  that  may  belong  to  an  article  of  food."  They  are  of  vari- 
ous kind-.  I'ickles  are  eaten  with  cold  meat,  especially  when  fat. 
Some  are  added  to  other  food  as  a  flavouring  agent,  as  the  onion, 
or  garlic.  Many  as  vanilla,  lemon,  almond,  ginger,  and  nutmeg  are 
used  with  milk  puddings.  Not  onlv  do  they  gratify  the  palate,  but 
they  serve  a  useful  purpose  otherwise. 

Sauces.-  Sauces  are  combinations  of  condiments,  more  or  less 
complex.  Some,  as  anchovy  sauce,  are  used  to  add  to  or  brinu;  out 
the  flavour  where  this  is  latent  or  little,  as  in  boiled  white  fish. 
Some  sauces  a  re  made  of  various  ingredients,  as  with  roast  duck  for 
instance,  n  is  common  to  make  a  sauce  by  stowing  the  giblets. 
chopped  tine,  and  mixed  with  the  gravy  in  the  dripping  pan.  and  to 
tins  some  finely  chopped  ehalot  is  added.  Such  is  a  savorv  sauce. 
To  some  .siiices  wim-  i-  regarded  as  a  '.rood  addition.  />>•  i/nxl ilms 
IK, n  il  i.- i,niii  n<l  n  in .  but  a  little  plain  "/raw  is  nicer  with  meat  anil 
vegetables  than  an  elaborately  made  sauce  including  port  wine.  - 
to  my  mind!  Sweet  -aiices  are  used  to  puddings:  and  rum  sauce 
was  once  in  "Teal  t'a\  >  >u  r. 

Thc!i  then- are  prepared  sauces.  ( 'atsup  is  an  old  favourite.  So 
H  India  -oy.  \1  M  •.  and  \  a  ried  a  re  tin-  sauces  and  relishes  now  maii- 
u fact  u red  and  -old.  I  larvey's  was  one  of  t  he  first.  As  an  all-round 
sauce  I. '-a  and  |Vrr  n'-  \\  oreester  Sauce,  "  >uade  from  an  old  recipe 
in  a  nobleman'-  kitchen."  i-  as  'jood  a~  anv.  It  is  .-aid  its  peculiar 


roNDIMKNTS       SATCKS.  41 

flavour  is  due  to  a  certain  admixture  of  asafu-tida:  tin-  exact 
amount  constituting1  the  secret.  Of  old.  tlie  flavouring  a^ent  was 
added  to  the  ragout:  hut  uo\v  various  sauces  arc  placed  U|MIII  the 
tahlc.  and  each  ^uest  flavours  for  himself.  There  is  no  hroad  rule 
like  that  of  mustard  \vit  h  heef  and  pork:  while  it  is  never  eaten  with 
mutton  and  sea  reel  v  with  hacon  or  ham.  \o  one  dream-  of  eating 
mustard  with  hoiled  chicken,  or  for<rettin<;  it  with  roust  ^'oose. 

( 'ond imeiits  are  ctiriouslv  omitted  from  tlie  dietarv  of  invalids. 
There  is  a  ireiieral  impression  that  the  plainer  the  food  for  them  the 
hetter.  lint  this  leads  to  a  ternhle  moiiotonv  in  the  dietarv.  Salt, 
is  often  forgotten  in  the  meat  hroths  of  the  acutelv  sick :  and  a  little 
Worcester,  or  allied  sauce  often  ^ives  a  /.est  to  a  palate  which  has 
heeii  palled  hv  plain  heel'  tea.  If  condiments  do  not  possess  a  true 
food-value,  thevare  not  without  a  value  of  their  own:  and  arc  not 
mat  ters  to  he  neglected  in  dietet  ics.  ( )f  chloride  of  sod  mm  or  com- 
mon salt,  its  utilitv  is  easilv  recognized;  though  its  r<>/>'  in  the  am- 
mai  eeonomv  is  not  quite  as  clear  as  could  he  wished.  I ioussinirault 
made  experiments  upon  o\en.  l>v  ^i\  mi,r  salt  to  some,  while  with- 
holding it  from  others,  which  told  unmistakahlv  of  its  value.  As 
to  the  food  value  of  vinegar,  it  is  not  easv  to  lind  anvthin<r  po>iti\c. 
Nodoiiht  it  is  changed  and  oxidiseil  in  the  hodv:  and  that  it  is 
a^i'eealjli'  to  the  palate  as  an  addition  to  many  articles  of  food;  hut 
hevond  t  hat  it  has  a  further  ut  i!  1 1  v.  "  It  seems  not  improliahle  t  hat 
as  Niiie^ar  powerfullv  excites  the  secretion  of  the  sali\arv  glands,  it 
exerts  a  similar  influence  upon  the  stomach,  augment  IIIL;'  the  How  <>f 
gastric  juice,  and  therehv  increasinir  the  digestive  power  of  the 
oi'ifans."  (Stille. )  Of  its  evil  effects  when  taken  to  excess  -  as  is  done 
liV  some  persons  for  the  reduction  of  ohesitV- — there  IS  no  iple-tloll. 

Condiments  are  atrreeablu  to  tlie  palate,  and,  in  moderation,  u'ood 
for  the  digestive  oririins. 


BKVK1IA<!KS. 

Water.-— As  well  us  food,  animals  require  drink:  indeed  the 
necessitv  for  the  latter  is  the  more  imperat  ivc  of  t  lie  1  wo.  (Mir  bod- 
ics  larirelv  consist  of  water;  and  our  secretion-  daiiv  entail  a  consid- 
eralile  quantitv  of  tluid:  while  for  excretion  a  certain  inilk  of  water 
is  essential.  ( >nr  t  issues  indeed,  are  hat  lied  in  fluids  which  at  once 
liriiiLT  nu!  riiiient .  and  earrv  awav  waste  matters.  'I'lie  ^ood  cll'eri- 
of  watering  places  are  largely  due  to  the  itii-rease  in  the  hulk  of  tluid 
taken  there,  irrespective  of  any  s  eeial  '|iiahtv  of  the  water. 
Especially  is  this  seen  in  the  ca.-e  of  ladies,  who,  as  a  rule,  habitually 
take  too  small  quantities  of  fluids  -for  ohvioiis  social  reasons.  Fur- 
ther there  is  an  impression  abroad,  that  ;t  is  undesirable  to  liiiute 
too  freclv  the  LTiistric  juice,  (hi  this  mailer  I'aw  savs.  "  \\ 'hethi-r. 
as  the  result  of  the  inlliience  of  this  notion  upon  the  public  mind, 
or  not ,  mischief  is  frequently  occasioned.  e>peciallv  amoirj-  the  higher 
ranks  of  societv.  hv  a  too  limited  consumption  of  thuds.  In-tead  of 
takinir  a  draught  of  some  innocent  and  simple  bevcraire.  it  is  at 
ma nv  tallies  the  fash mn  to  sip  fluid — and  t  hi<  a  more  or  less  st  ron'jflv 
alcoholic  one  onlv  from  the  wineglass.  It  is  a  mi-taken  notion  to 
think  that  when  we  drink  with  a  meal,  we  are  dilutini:  the  era-trie 
juice.  The  act  of  secretion  is  excited  h\-  the  arrival  of  the  meal  in 
the  stomach,  and  the  ^a.-tric  juice  is  not  there  at,  the  time  of  in^es- 
tion.  It  happens,  indeed,  that  the  ahsorptioli  of  fluid  takes  pla<-e 
•\vith  irreat  activitv.  and  the  liijiiid  which  is  drunk  durinir  a  meal, 
becoming  al).-orl>ed.  mav  \<c  looked  upon  as  proving  ad\antaLTeou-  !iv 
afterwards  eont  riluit  in LT  to  yield  t  he  ^a-tric  juice  \\  hie h  is  required.  " 
So  much  for  t  he  d  iiut  ion  of  the  -ja-tnc  juice.  Tln-u  there  is  the 
(jiiestion  of  e\i-retion.  ("rates  especially  are  sparmirlv  solnhle,  and 
require  a  certain  amount  of  dihit:on  for  then-  renio\al.  (loutv 
ladies  certainly  drink  far  too  little  Iluid.  and  more  \vatei1  is  nnques- 
t  ioua  I  ilv  desirable  in  t  heir  ease;  and  it  the  water  con  tai  n  some  alkal- 
ine matter  it  will  he  all  the  better  for  it.  Hut  whether  alkaline 
waters  .-hoiild  be  drunk  at  meals  or  not.  is  a  matter  on  \vhi<'h  npin- 
ions  mavdiU'er.  The  digestion  in  the  stomach  inx-s  on  in  an  ai-id 


I'.KVKI:  ACKS.  {:; 

medium:  mill  too  much  alkali  certainlv  seems  eontra-indieate  i.      (  >': 
the  other  hand  a  draught  of  such  water  half  an  h'-ur    bet'op- 
is  certainly  desirable.      To  provide  an  alkaline  hath  fur  the  n~-n,  . 
an    excellent    practice,  especiallv    lirst    tiling   in    the    morniir.: 
p'ttin^   out    of    hed.       Hut    it    is   also  \vdl    to   lake   a    second    ~;in;  ;il- 
draught   before  a  late  dinner.      That   is  one  a-pe.'t  uf  the  .-uhject. 

There  is.  however,  another.  Sidnev  Kinder,  in  discussing  a! kaiie». 
speaks  as  follows:  "  \\  e  wish  to  draw  attention  in  this  pia'-'-  \» 
one  important  property  of  alkalies— namely,  their  puwer  to  iti'Tca-e 
the  secretion  of  the  ^as  trie  juici  —  itself  an  ni-iil  secretion.  \\V 
venture  to  think  many  facts  warrant  the  following  ".vncrali/at  ion: 
thai  alkalies  applied  to  the  orifices  of  glands  with  acid  secretion- 
increase  their  secreting  power:  while  alkalies  applied  in  a  corre- 
sponding wav  to  glands  with  alkaline  secretions  lessen  or  clicck  the 
secretion."  It  is^'ood,  then,  to  take  alkaline  lliuds  before  a  nieai  in 
order  to  increase  the  flow  of  gastric  juice  as  well  as  to  wa-h  awav 
waste  matters  from  the  tissues. 

I  low  far  draughts  of  iced  water  at  meals  are  injurious,  either  to 
t  he  stomach  itself,  <>r  to  the  digest  ive  procos.  is  a  niuu;cd  point .  Iced 
fluids  have  ever  been  sought  for  in  hot  climates,  and  arc  certainlv 
agreeable  to  the  palate.  About  thai  there  is  no  doubt  or  ((iiestiun. 
The  All  stria  us  love  iced  beer  to  their  meals;  nor  do  t  hev  .-nll'er  from 
indigestion  therefrom:  especially  the  female  element.  How  far  the 
dvspepsia  of  Americans  is  due  to  their  free  use  of  iced  water-..  i-  a 
matter  on  which  some  persons  are  insistent :  but  lam  nut  in  a  po- 
tion to  "jive  an  authoritative  opinion  on  the  subject.  There  a:v  eer- 
tainlv  other  factors  in  opci'ation  in  their  ease. 

The  amount  uf   iluid    reipiired    dailv.  is   stated    to    be   about    ;i\e 
pints,  to  meet  the  watei'-loss  b\   the  kid  lie  vs,  t  he  skill,  and   the  .  \\  HL;-. 
The^a-tnc   juice  reijiin'cs    lliud.       The    bile  secreted,   the    panciva;..' 
flow,  and    the   saliva   ail    involve  a  considerable  bu,k    uf   water.       !'••  - 
vond  t  he  matter  of  dilution  of  secret  ions  and  Hushing  of  e.v ret  ;o;,-. 
there  are  t  he  re  la  t  ions  of  water  to  the  body  tempera!  lire.      'I 'he  , 
in";  etl'eet    of  \vater    passing    from  the  fluid    form  iu  tha;   uf  vap"::r 
the  means  of  keeping  down  the  bodv  tern  pe  rat  lire:    \\  Inch  oilier' 
\vouid  rise   to  a  point   incompat  ilile.  nut   \\;th  eapacitv  for  e\cr!,uM 
bill   with  life  itself.       I  to'j-s  which  do  n<it   pe'-spin-  pi'operiv  die 
climate.-.       \\' here  there  is  u'l'eat  e\halat  ion  of  water,  drink     • 
at  i\  c:   whet  her  il  be  in  the  tropics  or  the  heat  of  iron-work  -.  .. 
lioie>.      The  woi-kers  in    foiinderics,  and   iron    I'actur:.'-.  a:. 
measure  t  heir  drink  bv  the^aliun.       Hut  taking  per-i 


44  MAM'AI.    OF    DIKTKTICS. 

life,  the  amount  of  fluid  taken  depends  ,'erv  much  upon  what  it  is; 
whether  it  is  palatahle  or  otherwise. — and  whether  or  not  it  he 
charged  with  alcohol. 

Fluids  are  taken  with  our  meals,  and  are  essential  to  digestion, 
and  the  secretions  involved  in  the  digestive  act.  Hevond  that,  most 
fluids  chosen  for  such  purposes  possess  a  certain  stimulant  action. 
Alcoholic  beverages  were  once  the  drink  of  all  classes.  Now  tea, 
coffee  and  cocoa  have  largely  taken  their  place.  Hut  the  actions  of 
these  various  stimulant  I  leverages — as  stimulants  -will  cii^avv  our 
attention  in  the  next  chapter. 

Beverages  as  food-accessories.-  As  to  the  ell'ects  of  bev- 
erages taken  with  meals  upon  the  digestive  processes.  Sir  \\  illiam 
Roberts,  F.  H.  S. ,  of  Manchester,  has  recently  made  extensive  ob- 
servations. In  his  address  on  Therapeutics  at  the  Card  ill'  meeting 
of  the  Hritish  Medical  Association  in  July.  !>>."),  he  LT;IVC  the  follow- 
ing conclusions,  as  the  result  of  his  enquiry. 

"  In  studying  the  influence  of  our  food-accessories  on  digestion, 
it  is  necessary  to  distinguish  sharply  between  then-  action  on  the 
chemical  processes,  and  their  action  on  glandular  and  muscular 
act  iv  it  y.  These  two  act  ions  are  quite  d  ist  met .  and  ire  lie  rally  opposed 
to  each  other:  for  while  all  the  food-accessories  were  found  to 
exercise  a  more  or  less  retarding  influence  on  t  he  speed  <  if  t  he  chem- 
ical process,  some,  if  not  all  of  t  hem.  exercise  a  st  i  inn  la  t  intx  in  ll  netice 
on  the  glands  which  secrete  the  digestive  juices,  and  on  the  muscu- 
lar coin  ract  ions  of  the  stomach.  It  is  also  necessan  to  distinguish 
between  t  he  ell'ect  s  of  the  food-accessories  on  sal  i  va  rv  d  ILTC-I  ion.  and 
their  ell'ects  on  pept  ic  digest  ion.  inasmuch  as  wide  d  i  ver^encies  were 
found  to  exist  in  this  respect.  The  distilled  spirit-  brandy,  whis- 
key, and  irin,  were  found  to  have  but  a  trill  MILT  retarding  effect  on 
t  he  diirest  i  ve  ]  rocesses,  whether  salivary  or  pept  ic.  ;  n  the  proportions 
in  which  they  are  commonly  used  dieteticallv.  Then-  obstructive 
etl'ects  01  dy  become  apparent  when  u-ed  in  quant  it  ies  which  approach 
intemperance.  Taking  tins  in  conjunction  with  the  st  Imulat  in<r 
action  whicli  they  exercise  on  the  glands  which  secrete  the  diirestiyo 
juices,  and  on  the  muscular  act  i  vit  y  of  the  stomach,  their  ell'ect  in 
the.-e  moderate  dietetic  proportions  mu-t  be  regarded  a-  distinctly 
p ron lot  ive  of  d  :j^est  ion. 

"  Wine  and  malt  liquors  exhibited  an  act  ion  dill'crni:  , -on  -iderablv 
from  that  of  ardent   spirits        \\ine~were    found    to    lie    hLdih 
ical    to   salivary   digestion.       Kveu    very   small    quant'tie-    of    - 
claret,     hock,    or   champagne,     inhibited     'he    action   ,,'' 


r,K\  KI;A<;KS.  i;. 

starch  to  :i  very  hijrli  decree.      'I'liis  i<  due  to  t  he  con-:derai>! 
which  ail  wines  possess.       When    this  m-iditv  was    neut  rai  i/.e  ; 
addition  of  an  alkali,  the  inhibitors-  ell'eets  of  \vine-  on    -tarcii-d 
t  ion  was  entire! v  removed.       It  is  a  com  mi  in  p;-a< •;    •,•  to  m .  \  v.  .  v  •- 
especially  sherry,  claret,  and  hock      with  soda,  -eii/er  or  sum.-  ..;  !,--r 
effervescent    tahle    waters.       These    water-   ail     contain    a    ehar;j 
alkaline   carbonate,    and    it    \vas    found    that,  when  wines  were    tin; 
mixed,  thev  ceased  to  embarrass   the  salivarv  act  ion.      Thi-  practic 
mav  therefore   lie    looked    on   as    hiLThlv  commendable    in    the  ca->-  of 
persons  of  weak  digestion. 

"On  pept  ic  digest  ion.  wines  exhibited  a  retarding  effect  aho^.-t  her 
out  of  proportion  to  the  alcohol  contained  in  them.  I'mth  th" 
st  1'oiiLfei' and  the  lighter  wines,  except  ;n  \ej-v  moderate  proportion-, 
checked  the  speed  of  the  peptic  digestion.  In  the  eustomarv  d:<'t- 
etic  use  of  wines  with  meals,  there  is.  probablv.  a  douli'ie  action:  on 
the  one  hand,  a  stimulating  action  on  the  secretion  of  gastric  ju;.-'-. 
and  on  the  iniiscular  contractions  of  the  stoinai-h:  and  on  tin-  othi-r 
hand,  a  retarding  elTect  on  the  sp^ed  of  the  (diemical  process.  In 
the  ease  of  persons  of  weak  digestion,  wines  should  lie  tak'-n  s[iar- 
in^ly.  and  the  qiiantitv  so  adjusted  as  to  hrin^  out  their  s' imiiiat  in^ 
action  without  provokini:  the  retarding  etTects  which  follow  their 
more  liberal  use.  ( 'liampa^ne  was  found  to  have  a  distinctly  .••--- 
retarding  power  than  an  eipial  volume  of  claret  or  hock.  Th;.-  1 
judged  to  be  solelv  due  to  tlie  mechanieal  ell'eets  of  t  he  elYerves. -eiiee. 
and  lilieratiou  of  ^a>,  wliei-ebv  a  nnTe  etlideiit  stirring  up  "*'  '.'c' 
diLfcst  MIL:  mass  would  be  elTected.  I'ltTcrV'-^eeiit  wines  t  heivfor.-. 
other  things  lieini:  eipial  -favour  the  speeil  of  peptic  digestion  more 
than  still  wines. 

"  The  ell'ccts  of   tea.   colTee,    and   cocoa  exhibited    some   i  lit  el'e-t  ; :  ;_r 

diversity.       It   was  found  that  tea  had  an  inhibitory  eU'ect  on  sai;\ 
digestion;   even    in  verv  minute    propoi-t  ion.   ;t    eompleti-iv  pai'alv-" 
the  act  1011  of  saliva.      <  hi  the  ot  her  ha  nd.  ci  ill'ec  ;i  nd  eoi-oa    had  •> 
a  slight  "11',.,'t  on  salivarv  digestion.      The  inhil>itorv  action  of  tea  ..n 
saliva  was  found  to  be  due  to  the  laruv  iiuantitv  of  tannin  conta  ne.'i 
in  the  lea-leaf.      Sonic    persons    hiive  supposed    that    liv   mfu-:n^' 
for  a  verv  brief  period  — t  wo  or  three  minutes   -the  pa --a  if'1  " 
into  the   beverage  could    be  avoided.       This.   howcNei'.   is   a 
Tannin  is  one  of    the  most  soluble   siih-ianees    known,     ' 
SH^I  r  in  hot  water.      ( )ne  ifent  Icmaii  of  m\   acijiiaintanc-1. 
ror  of  tannin,  was  in  t  he  hab:t  of  preparing  h ;-  lea  bv  pl.-i 
leave-    on  a    paper- tiller,  and    simplv  |iour;nur   "n    tin-    iio.  T. 


4»i  MAM   Al.    <>!•'    DIKTKT1CS. 

In  this  way  he  thought  to  evade  the  presence  of  tannin  in  his  tea. 
P»ut.  if  von  try  the  experiment,  and  allow  the  product,  as  it  runs 
through  the  filter,  to  tall  into  a  solution  of  perchloride  of  iron,  you 
will  lii  id  that  an  inteii.-e  inkv-hlack  coloration  is  produced,  showing 
that  tannin  ha s  come  t  hrotiu'h  in  ahundunee.  YOU  can  no  more  have 
tea  without  tannin,  than  you  can  have  wine  without  alcohol;  and  I 
found,  experimentally,  that  tea  mt'ii-cd  for  two  minutes  had  almost, 
exactly  the  same  inhibitory  eifcct  on  digestion,  as  tea  infused  for 
twenty  or  thirty  minute-.  If  you  wish  to  mitigate  the  ell'eci-  of  tea 
on  -aluarv  digest  ion.  you  should  direct,  the  patient  not  to  sip  the 
beverage  with  the  meal,  hut  to  eat  lirst  and  drink  afterwards.  In 
this  wav  time  is  ^iveii  to  the  saliva  to  perform  its  functions  unhin- 
den^I.  Another  device  is  to  introduce  a  pinch  of  carbonate  of  soda, 
into  the  teapot;  tins  removes  the  deterrent  ell'ect  of  tea  on  salivary 
digestion;  it  is  a  practice  occasionally  followed  in  some  households, 
under  the  idea  that  soda  helps  to  extract  the  virtue  of  the  tea-leaves. 
It  was  found  that  the  addition  of  so  small  a  proportion  as  one  per 
cent,  of  the  weight  of  the  dry  tea.  trreatlv  mitigated  it-  injurious 
ell'ect  on  starch -digest  ion,  and  t  hat  twice  this  <piant  it  v  (t  \v<>  per  cent. ) 
a!mo.-t  entirely  removed  it.  This  latter  proportion  corresponds 
rouirhiv  to  ten  grains  of  bicarbonate  of  soda  to  an  ounce  of  tea-leaf. 
"  The  ell'ects  of  tea.  colTee.  and  cocoa  on  peptic  digestion  were 
found  to  he  as  nearly  as  possible  a  1  ike  for  infusion  of  e(|iial  st  ren^'t  h. 
Ail  three  exercised  a  retarding  etl'ect  when  their  proportion  in  the 
digest  m<r  mixture  rose  above  twenty  per  cent.  The-e  beverages 
should,  therefore,  be  taken  very  moderately  by  persons  of  weak 
digestion.  The  ioiod  reputation  of  cocoa,  in  regard  to  dip-stion. 

Seems   to   lie   who]  i  v  d  lie  t  o   the  fact    that.   It    IS   Used    ill    Weaker  111  I'll -ions 

than  tea  or  cotTee.  The  directions  for  the  preparation  of  this  bev- 
erage printed  on  the  packets  of  cocoa  sold  in  the  shop-,  indicate  a, 
stren'_rt  h  of  about  t  wo  per  cent. :  whereas  a  medium  tea  is  u-uallv 
made  of  a  st  ivniM  h  of  foil  r  or  live  per  cent :  an  1  a  im-d  i  u  m  ei  'll'ee  of 

a   Strength   of    live    to  SeVell     per  cent.        The   strong  coU'ee    which     It     IS 

eustoina  rv  '  o  hand  around  aft  IT  d  inner  m  u-t  have  a  power!' n  1  retard- 
ing" ell'ect  on  LTastrie  digestion:  and  although  tins  practice  may  lie 
saiutarv  to  robu-t  eater-,  it  is  not  to  be  recommended  to  tho-e  of 

feeble    peptic    power.  " 

I  have  preferred  to  make  tins  loiiif  ([notation  ;n  order  to  let  I 'r. 
Roberts  -peak  tor  hiniM-lf.  as  an\'  summar\'  nnidn  ^ive  !'!-e  lo  -ome 
misconceptions.  \\  he  t  her  his  concl  u-ion.-  will  be  en  1 1  rely  confirmed 
by  othei1  observations  or  not.  we  mav  feel  pretty  confident  about  the 


main    l'aets.      The  well-known  eil'rrt    nf"!ii_!i    tea"  •'.•..  ••  iw.; 
solid    meal.   seeiiH  to  tiiiil    its  explanation  in    the  e!l'ee;~  of    ;.  a  .:>  p. 
tardin^  digestion  and  espeeiallv  salivary  di_r<-t  \«\\.      If  tin-  i;._- 
of  -taivh   hr  thwarted  and   ;i  quantity  of   u  M'lo'-t1' !    -tar- 
in  t  IP-  stoinaeh.  no  wonder  if   pain  and    still    more  ila;  u.  '•;,<•'•    !,«•  c\- 
[M'Hi'Mrt'il.      Tin4  t'uiiil  slimiM   In-  eat'-n  — sav  \v;tii  a  htt!i-  '-!l'<-r\  e-rcnt 
watrr — :unl  then  tin-  tea  drunk  afterwards,  liy  t  h"~>-  who-,  -diui'-;  i"H 
is  nut    that    lit'    the  ostrich    il-i-M'.      Thf    t'i>ii!:'!'-r  <>\   "  lii^h    t>-a  "  \vas 
ccrtainlv  nut  a  hriu-fartnr  nf  h:s  >j»fi-ics:    n«ir  in.ici-.]  IKI--  t  !:••  i:.1  r<  «]}[>•- 
tioii  of  te;i  t'rnlii  Cliina    -a  stat  n- i-i'iintrv.  ;:i;»  Kn^.aMii.  a '-"li:::  r-\  •>!' 
ilistiiii't    ailvaiiei — ainl   frmn    t  IH-IP-C  v/hfi-i-vi-r    I  In-  AiiL^o->a\'>;i    has 
sprca'1  hinisclf.  hrcn   an    unalloyed   ^i.u.l.      Tea  and  datnin'r  (a  rake 
of  doti'_rh  \vit  In  HI  t  lea  ven  i  >i'  veast )  ina\    he  a  im-al  "f  sun  i  <.<•  i-hara'-ter 
and    easily  prepared,  hut  nothing  ean  he   -ai'i  fur   i:   from    a    dietrtic 
point    of   vie\v.      No   wonder   that    indigestion    is  as  euinnion  ainoii^ 
t  lie  >turk-rider<  of    A  us!  ralia  a-  aiiion-'    those  of    \e\v    Me\,.-o.      Tea 
inav  he  drunk  as  a  refi'eshin^  stimulant  lu-vera^'e:   hut  it  is  HOI  di^ir- 

ahli-  as  a  food-aeeessorv.  especiai'.y  \vliei~e  the  f 1  is  iar^e.v  farinae- 

eous. 

As  to  wliat.  Sir  \\".  Koherts  says  a!  out  the  ur 1  elVeets  of  tiie  mi\- 

inir  of  clTcrveseinir  water  with  wine,  and  theai-tion  of  the  iiU-ratrd 
earliotiie  aeid  'jas  upon  the  di^i'-tin^  I'oo.i.  n  ijui',.'  t'al.~  :n  \\ith  n;v 
own  i-xperieiire  personal  and,  pi'oics.-'.onal.  in  the  niaii'-r  «'.  ina.;  .;<|- 
uors.  1  had  he^'iin  to  ohservt- that  for  invalids  and  eonvale-'-en'-.  ail 
niait  r.i|iiors  should  he  m  i^ood  eoiidit  n  in.  < .•  . .  \v*-ii  (diaru'e'i  w;:  h  . -ar- 
houie  a.-id;  and  that  if  "  llat  "  or  "  deai'i  "  tiiey  distinetiv  d:.-aLrreed. 
wlien  a  lii-n-e  attack  of  si-arlet  I'cviT  left  me  in  a  position  I"  lake 
further  ohservat ions  on  mvself.  \\ith  the  re~ult  that  inv  impre— ions 
were  eontiriiied.  'I'he  hherated  eai'lioiii'-  aeid  w;is  a  p"~.:.\'-  uood  : 
while  t  he  ai -etie  acid  of  ' '  llat  "  mai t  liijuor  wa^  as  ilisi  ;iit  ; ,  \  injuri- 
ous. \\  e  al-o  from  this  eau  understand  the  value  of  cl'fer\'e-i';n^ 
\vme<  over  still  wines  in  t he  siek  room.  I'rohalil  v  a  lit  tie  pure  -p;r;l 
\\'it  h  an  elTervesei'nt  water  is  t  he  he-t  drink  for  ;i  dy>[>eptie  or  iinahd. 
and  is  commonly  adopted  hv  sudi  [lersons, 

l-'roni  what   has  just  lieeii  said  ahoiit   thf  etVeet  of  earl'oii;-'  a>'.d  .n 
ih'1  Hoinaeh    upon  dip'stniLT  fond,  \l\i-    non  medical    r«'a  .'•;•  : 
run  away  with  the  idea  that   llatillenee  ouirlit   !o  a—i~;   d;-'"- 
iiotorions  faet    hi-inur   that    llatillenee    :~  a  --real    pur: 


4S  MA  NT  AT.    OK    DIKTKT1CS. 

eludes    his   discussion   on   alcohol — ''However   little   a    man's   purse 
allows  him  to  drink,  let  it  be  j^ood." 

That  winesand  malt  liquors  have  an  action  upon  the  stomach. 
which  is  pleasant  and  irratet'ul.  is  a  fact  most  people  know  for  them- 
selves. That  they  stimulate  the  trast  ric  flow  and  increase  the  mus- 
cular act  ivit  v  of  t  he  stomach,  is  probably  the  underlying  cause  of  the 
sense  of  well-beinu;  which  accompanies  their  use.  Consequently  in 
atonic  dvspepsia.  —  whether  primarv.  or  secondary  to  a  jjeneral  con- 
dition of  debilit v  —some  combination  of  alcohol  and  carbonic  acid  in 
dilute  form  is  indicated.  But,  <>f  course,  this  is  not  to  lie  made  a 
rule  absolutely  to  apply  to  all  cases.  There  is  a  well  recognized 
form  of  indigestion  which  is  intractable  to  all  medicine  and  regimen, 
except  the  avoidance  oi'  lluids.  A  dry  dietary  is.  a  swift  cure. 


ST I.MT  LA  NTS. 

TIII<  chapter  rovers  ;i  vexed  ^''"iiml  —  a  debatable  land,  where 
views  are  in  fierce  conflict.  SirouLi"  feelings  ha\e  liccn  thrown  Into 
the  scale:  am!  liccl'-tca.  vegetable  prmeiplrs  (as  theiiie  ami  eall'e'.m') 

and  aleolmi  have  assailants  ami  supporters  \vho  ! fti-n  ilo  nut  ^ive 

cacli  otliei1  fair  plav:  ami  use  declamation  m-tead  of  argument —in- 
deed, sonietinies  the  ilcclatliat  Ion  1-  Mi  inverse  proportion  to  the 
argument,  eonsiMjUentlv  !  eanimi  e\peet  t<>  please  all  b\  \v!i;.;  will 
lie  \vritten  in  this  chapter:  certainly,  not  the  e\tiviiii.-ts  m  eai-h 
U'illLT- 

Stiniulants  divide  tlieinselve<  into;  (1).  animal  and  ve^etah'.e 
snhstaiiccs  of  \vhich  M  H  ro^vn  is  the  cons|iicnous  faetor  ^as  ,t  i<  o!'  a!. 
explosive  coin  pounds):  and.  ('.').  alcohol. 

.1.     Animal  principles.-   Ueef  tea   may  stand   as  the  typi< 

representative  of  stimulants  derived  fr"iii  animal  f 1  at  the  pre-em 

tune,  and  in  the  present  >tate  of  pnlilie  opinion.  ^'e!  ;i  ;  seareelv 
a  food—  a-  seems  so  tin  i\  ersall  v  ass  tuned.  'Mi  t  he  verv  t  hresliold  of 
tin-  ehajiter  it  liecoines  iiecessarv  to  slav  a  popular  conviction. 
\Vhen  the  relatives  of  a  sick  [icrson  tell  one  in  all  earties:,  of  the 
aniouiit  of  heef  thi'v  have  converted  into  heel'  tea.  and  ho\v  tin- 
patient  has  been  sustained  thcrehv.  it  is  with  dilVieiilty  thai  ihe 
mnsides  of  expression  are  prevented  from  throwiiii:' a  der;si\c  >in;!f 
over  the  feat  u  res.  "There  is  no  pain  like  the  pai  n  of  a  new  idea  " 

according   to  lia^ehoi;  and    to   tell    these  i;- !    peopic   that    the\  are 

siniplv  talking  nonsense  that  in  faet  thev  do  not  nmier-iaip;  \\;;ai 
they  are  talk  ini;  alioiit.  would  !»•  to  inili'-t  iijion  them  a  -,••>••:•••  k; 

and  \vould  prohalilv  arouse  a  feclimj;  of  di-tnist  rat  her  t  nan  an\ : : 
else  in  I  heir  mind,-.       In    fad.  n   would  seareelv  he  a  >afe  C\IM 
ni   most   lioiiM-hoids.      Still,  all  the    same,  to  ^ive  hei-f  ;•  a  a  "'.' 
,-iek  person    is   to  tjive   him  a   st^ne  ulien    he  asks    for  '       d.      i' 
not  a  food,  it    is  a   stimulant!      (Jraieful   and    aeceptaMe  a,.! 
paiale  and    ihe   stomach,   possessing  >;  imnlat  iic_;'    pro;i.-i"     -. 
ha-  it-  \aliie.       lint  all    the  same,  as  regard.-  it-    foo.;-\a.i;«^|  .' 
a  jackass  in  a  lion's  skin. 


.><>  MAM    AI,    OF    MKTKTirS. 

\\"li:it  can  really  In-  said  t'«>i-  it  ? 

It  is  a  decided  stimulant.  \\ hen  flesh  i<  boiled  its  albumen  is 
eoatrulated.  That  i>  a  simple  fact.  l>eef  tea,  as  ordinarily  pre- 
pared, contains  no  albumen.  The  fluid  so  olttaincd  is  rich  in  ex- 
tractives and  salines.  There  are  present  t  he  phosphates  of  the  flesh 
in  solution.  The  extract  ives  are  nit  rop-nixed  bodies  kreatin  and 
ki'eatinini  —  the  tir-t  with  the  formula  ( '  II  N  <>  and  the  latter*'. 1L 
N  (>:  which  means  kreatin  is  a  hvdrated  form  of  kreat  'mine  are 
found  in  meat  juice  and  muscle  extract-:  hut  t  hev  belong  rather 
to  muscle  as  derivatives  -as  histolvtic  rather  than  histo^enetic 
matters.  In  oilier  words,  whidi  can  he  understanded  of  the 

] pie,  thev  are  not  material  of  which  muscle  can  he  built  up:  but 

rather  stand  as  eil'ete  muscular  matter  ;n  tlie  road  to  urea.  Albu- 
men is  material  of  which  and  from  which  tissue  can  be  formed.  It 
is  like  the  bricks  which  arc  ^oin^  to  form  the  walls  of  a  new  build- 
ing. Kreatin  and  kreatininc  are  rather  the  old  bricks  and  mortar 
of  an  old  !iu ; id  mi;'.  (  which  have  served  their  da v )  coming  down  to  ho 
carted  awav  as  rtibbi-di.  The  liquor  saniniinis  brings  the  one  and 
removes  the  other:  jnsi  as  contractors' carts  mav  be  seen  together 
when  build  mil's  a  re  beinir  pulled  down,  and  rebuilt,  the  one  laden 
with  new  bricks  l'<  >r  'new  walls,  tin.-  other  lii  led  with  t  he  //<///•/>•  of  old 
walls.  Now  1  tru-t  tip'  matter  is  unmistakable.  These  extractives 
are  not  food-material  for  tissue1:  but  stimulant-.  "Kreatin  and 
kreatimne  arc  products  of  the  vital  process  and  constituents  of  the 
flesh  of  all  vertcbrata  hitherto  examined.  Human  flesh  is  particu- 
larly rich  in  kreatin."  ( I  .icbi--.  )  It  is  easy  from  this  to  understand 
whv  sa  vai_rf'S  at  e  the  bodies  of  their  eiieiii  .  !!<_;•  1  MI  man  flesh  to 

endow  them  with  courage.  No  doubt  A  did  ,-timulate  them  and 
make  them  feel  warlike;  ju-t  as  |tomin;e  Samp-on  felt  exhilarated 
bv  sonic  of  the  contents  of  the  ^jip-v's  cauidron.  saving,  "  \  enlv  1 
feel  mi^'htv  elevated  and  afraid  of  no  e\i]  which  mav  befall  me;"  a 
\erv  dilTerent  mental  condition  from  that  in  which  he  was  when 
MI-L;-  Merrilies  accosted  him  at  the  I\a;m  of  I  )erncleuv;h.  Of  the 
st  i  m  u  Ian  t  efTect  s  of  meat  extract  ive-.  of  i  he  utility  of  the  meat  salts 
in  beef  tea,  there  is  and  can  he  -..:••-:  ion.  lint  it  is  destitute 
(practical! v )  of  matter  which  can  <•-,,  r  form  tissue;  and  is  e.piallv 
without  value  as  fuel-food. :-':  As  a  food  .:  i-  an  impostor,  neither 
more  nor  less.  A-  -ome  reader-  mav  fi-''l  indignant  a'  this  state- 


sTi.Mn.vNT>.  ;,  i 

711011  1.  ami  Mini:  "lit  that  tin-  import  un-  lies  rather  \vi:li  the  writer. 
lot  Sir  \\  il'dam  Robert^  once  more  be  heard: 

"  l>ecf  toa  ami  its  oon^M-ners  take  rank  as  restorative-  ami  -timu- 
lants.  rather  t  ha.ii  as  nutrients.  T  he  \  contain  no  album!  mm-  mat  ter 
in  .-ointion.  ami  the  small  amount  of  gelatine  contained  in  th'-m 
cannot  he  of  mm-li  aeeoiint.  There  is  a  widespread  misapprehension 
aiming  tiie  public  in  regard  to  the  nutriti\e  value  of  1  .....  f-te.-i.  The 
notion  prevails  that  the  nourishing  qualities  of  the  meat  pas-  into 
the  doeoet  ion.  ami  that  the  drv,  hard  remnant  of  meat  fibre  \vhieh 
remains  undissolved  is  exhausted  of  its  nut  rient  properties;  and  this 
latter  is  often  i{iven  to  the  eat  or  do^-,  or  even  as  1  liave  known. 
thrown  awav  as  useless  rnhhish  into  the  midden.  A  deplorable 
amount  of  waste  arises  from  the  prevalence  of  this  erroneous  notion 
in  the  households  of  man  v  who  can  ill  all'ord  it.  The  pro;  e  id  matter 
of  meat  is  quite  insoluhlo  in  boiling  water,  or  in  water  heated  above 
Itio  Fahr.  Tlie  ingredients  \vhieli  ]>ass  into  solution  ;iro  the-ai>id 
extractives  and  aslines  of  the  meat,  and  nothing  more  oxeept  s^me 
trilling  amount  of  ^v  lat  inc.  The  meat  remnanis,  on  t  he  ot  her  hand. 
contain  the  actual  nutriment  of  the  meat:  and  if  this  be  heat'-n  to 
a  paste  with  a  spoon,  or  pounded  in  a  mortar,  and  diilv  flavoured 
\v;th  salt  and  oilier  condiments,  it  const  itut-es  not  onlv  a  hiirhlv 
nourisli  mjj;  and  agreeable,  but  also  an  exceedingly  digest  ible  form  of 
food."  Yes.  |)r.  Roberts,  and  thero  is  amit  her  ;*  deplorable  waste  " 
involved  in  this  ei'ror  and  that  is  a  "  deplorable  waste  "  of  Imman 
life:  hundreds  of  our  fellow-creatures  are  dailv  dropping  into  their 
graves,  unfed,  unsuccoui'eil,  because  beef  tea  is  ^i  veil  as  a  1'ood  — 
^U'lven  for  what  it  is  not  ! 

I  )o^s  may  starve  on  lixiviated  meat,  and  even  turn  from  it  with 
loathing:  for  this  moat  lacks  t  lie  salts  and  oxtractives.  Hut  all  'he 
same,  human  beings  cannot  sustain  life  on  salts  jiml  oxtr:icti\e-;  with- 
out the  ot  licr  const  it  uen  ts  of  llesh.  So  i  Jierc  is  a  not  her  error  I'iown 
to  [lieces,  and  a  cherished  conviction  dest  roved  !  I.iclii^  himself  knew 
onlv  too  well  that  meat  broth-  liave  no  true  food  \aiuc.  aici  ad\o.-a;.'d 
cold  drawn  infusions  of  meal  .  Such  infusions  are  food  ;  and  food  of  ,•< 


1    can  seo   sundrv  readers    !ia\m^    been    driven  pa-!    the   stau'e   of 
incrediilitv    l»v   the    hard    lo-j'ie.   of    facts,    wrniii'iim'    tiieii1    ha:. 
anguish  over  t  lie  thought  of  depa  rted   relat  i  vos  who    have  bee- 
tically  starved    to   death  on    beef   tea.      \\'e  can    fee!    for:!i-! 
oaiilio!   heipiheiu.      "let  the  dead   pa-t   Imrv  its  dead  •  ••>••  ••-,  ,  •)•  we 

mav  sorrow  for  them!      Let   us  be  wi.-er  m  the  comn  •_•  •  M 


->-J  M  ANTAI.    OK    niKTKTICS. 

Tile  mistaken  views  about  the  nutritive  value  ot'  beef  tea  have 
been  murderous.  All  the  bloodshed  caused  b\  the  warlike  ambit  ion 
of  Napoleon  Ls  as  nothing  compared  to  the  mvriads  of  persons  who 
have  sunk  into  their  graves  from  a  misplaced  confidence  in  the  food 
value  of  beef  tea.  Asa  food,  it  is  but  as  the  mirajje  of  water  seen 
bvtlic  thirst  v  traveller  in  the  desert:  there  is  no  real  water.  So 
with  berf  tea.  it  is  not  a  food..  A  traveller  once  requested  some 
chicken  broth  at  an  inn.  when  brought  its  quality  was  very  indifl'er- 
ent.  Complaining  that  there  was  nothing  of  the  chicken  about  it, 

1  .  i 

the  waiter  assured  him  lie  was  mistaken  "  It  was  made  from  water 
from  a  pool  in  which  a  chicken  had  paddled!  "  In  so  far  as  the  fluid 
was  "'  chicken  broth  "  is  beef  tea  a  food! 

What  says  Kin^  Chambers:  "Make  the  cook  understand  that 
the  \irtue  of  beef  teai.-  to  con  t  a  i  ii  a!  1  t  he  contents  and  flavour-  of 
lean  beef  in  a  liquid  form:  and  that  its,  vices  are  to  be  sticky  and 
stron if  and  to  set  like  a  bard  jellv  when  cold.  When  she  under- 
stands this,  let  her  take  half  a  pound  of  fresh  killed  beef  for  everv 
pint  of  licet'  tea  required,  and  remove  ail  fat.  sinew,  veins  and  bone. 
Let  it  be  cut  into  pieces  under  half  an  inch  square  and  .-oak  for 
twelve  hours  in  one  third  of  the  water.  Let  it  then  lie  taken  out 
and  simmered  for  two  hours  in  t  he  remaining  t  wo-t  hirds  of  the  water, 
the  qiian'itv  lost  bv  evaporation  heimj;  replaced  from  time  to  time. 
The  boiiiuLT  liquor  is  then  to  be  poured  on  the  cold  liquor  in  which 
the  meat  ^'as  soaked.  The  solid  meat  is  to  be  dried,  pounded  in  a, 
mortar,  freed  from  all  strin^v  parts  and  mixed  with  the  rest." 

Th:s  last  matter  is  the  important  matter,  to  restore  the  meat 
fibrine  to  the  fluid.  That  it  is  which  udves  food  value  to  the  meat 
infusion.  ,\t  the  Victoria  Park  Hospital  we  have  recently  had  the 
beef  tea  prepared  on  this  plan  wh;ch  Mr.  Chambers  calls  "  whole 
beef  tea  "  and  though  at  first  the  patients  do  not  like  it  so  wel  1,  it  is  of 
course  much  better  for  them.  The  nitron-nixed  principle-  derived 
i'n  'in  meat  are  a  descending  series  which  commence  wit  h  k  real  in  and 
kreatinine  and  pas-  into  tvrosin  and  leiicin  bv  an  oxidation  towards 
the  final  products,  uric  acid  and  urea.  As  -aid  before,  all  explosive 
bodies  contain  nitrogen,  and  these  nil  ro^en;  xed  bodies  do  not  supplv 
force  in  themselves,  but  thev  liberate  stored  force,  converting  it  into 
'•  kinetic  enerirv."  Thev  are  hke  the  fulminat  MIL:'  mailer  of  a  ear- 
trid'_re  which  does  not  itself  propel  t  he  bullet,  but  which  explodes  the 
fiinpowder  whose  decomposition  is  the  real  propelling  power.  Con- 

Sei|llelit  i  V   to   u;i\  e   t  In  Mil   alone  to  a  .-:•  'k    per-oll    i-    to  e\  hat!-t    the   -t  ored 

up    material — the    "potential     ener;_;\        \vho-e    oxidation     produces 


sTi.MU.ANTs.  ;,:; 

force.  They  should  properly  be  accompanied  hv  some  soluble  carbo- 
hydrate. To  give  them  alone  is  as  illogical  and  erroneous  a-  it 
would  be  to  thrust  a  bullet  down  a  1:1111  barrel  and  put  on  a  i-:i|i.- 
omitting  the  powder.  These  explosive  nitrogeni/.ed  bodies  plav  an 
interesting  and  important  part  in  the  eronoinv.  A  carnivorous  ani- 
mal could  never  catch  an  antelope  in  a  dear  run.  luit  it  can  make  a 
supreme  eil'ort  and  pounce  upon  its  herbivorous  pivv.  And  this  ii 
can  do  by  the  nitrogcni/.ed  elements  derived  from  its  t',,,,,]  Hesh. 
(Ireyhounds  are  fed  on  meat,  because  tliev  require  to  put  forth  im- 
mense encrgv  for  a  brief  period.  Sport  in  i;  do  ITS  \vlio  cover  i"Ui:  d  - 
tances  in  a  day — but  at  a  less  rate  of  speed,  are  fed  on  hrot  h  and  oat- 
meal. And  the  same  occurs  in  the  feeding  of  horse>.  Trainers 
will  tell  you  that  the  hunter  ami  the  draught  horse  reipiire  to  be 
feil  ditl'erent  ly.  The  hunter  is  bred  and  fed  for  speed  and  carrv- 
ing  power:  the  draught  horse  for  l)iilk  and  strength.  In  the  hunter 
is  wanted  rapid  liberation  of  ener^v  within  a  eonijiarativelv  short, 
space  of  time;  in  the  draught  horse  is  wanted  a  more  gradual  liber- 
ation of  enei'^v  and  fora  longer  period.  To  bntrr  out  I  hese  <mali- 

•     ,  •  I 

ties  each  strain  must  be  fed  appropriately.  The  hunter  i>  fed  on  a 
concentrated  and  stimulating  form  of  food  — ehiellv  on  the  heaviest 
and  most  expensive  oats — which  if  1  mav  so  express  it.  is  the  "  beef  " 
of  the  vegetable  feeders;  and  unless  lie  is  M>  fed.  he  will  not  perform 
satisfactorilv  in  t  lie  hunting-Held.  The  draught  horse  is  fed  on  a 
lower  and  less,  stimulating  diet — on  Indian  corn  and  chopped  hav- 
t'ood  which  tends  to  increase  bulk  and  weight,  (Sir  \Vm.  Ilfiberts" 
£i  Lectures  on  I  lietetic-  and  Dvspepsia  ").  Not  onlv  is  this  so.  but 
when  the  ground  is  hea  vv  t  lie  hunter  gets  some  beans  or  pea-  ext  ra 
legumes  which  are  speeiallv  rich  in  nitro^eni/ed  principles;  ulnie  in 
plough  MIL:'  time,  especiallv  in  spring  when  the  hard,e.-t  a^r:'".i!i  ural 
work  is  performed,  the  farmer  adds  a  liberal  amount  of  oats  daily  to 
t  he  ord  inarv  food  of  his  horses. 

This  rule  applies  to  races.  The  conquering  Auu'lo-Sa\on.  the 
master  and  too  often  t  he  exterminator  of  aborigines  whose  lands  he 
covets  is  a  meat-eating  man  /xrr  <trrrl  ...  lli-  carm\oi'ou>  pro- 
pensities arc  linked  in  some  subt  i  Ic  manner  with  In-  ma-tcri  nine--. 

/-'.     Vegetable   principles. —Clo-elv  allied   i 
position   as  well    as   in    ph\siolo^ical    action    to    the  animal    m:: 
stand   a  certain    irroup  of   \e^eta!i!e    principles.      Tea.  e, .;%•••.  • 
and  to  a    less  extent,  male,  or  I'arau'iiavan    I'1::.  ;ire  mad 
sionswilh  hot  water  and  drank  as  food-accessories, 
supplv  at  once    llnid    fur  diireslive  purposes,  and  a  ci-rla. 


.".  1  MA  NT  A  I.    OK    IMKTKTICS. 

eil'ect  which  has  doubtless  liccii  t  h«'  cause  of  their  adoption.  Theme 
witli  a  formula  ('.II,  \.<>  is  the  tvjic  of  these  principles.  They 
are  a  considerable  iri-onp.  commencing  with  theine.  calTcine  and 
t  heoltrotniiie.  and  ending  with  hnicine  and  st  rveliniui'.- — a  mighty 
tonic  of  toxic  proper!  ie-.  St  rvchnine.  \vit  li  a  formula  of  < '..,  1 1  ,\  ..< )..  is 
constant  Iv  used  as  a  tonic  of  rapid  action  so  as  to  come  under  the 
head i ni:'  of  dill'usible  st  i umlauts.  When  the  Resident  Medical  ( Mlicer 
of  the  Leeds  I'll  hi  ic  Dispensary,  where  I  could  command  an  v  amount 
of  drills  of  everv  kind. — hut  where  meat  and  drink  were  hevond 
mv  reach.  1  found  in  many  cases  of  debility  and  convalescence 
from  acute  disease,  that  ammonia  and  mix  vomica  in  combination. 

supplied    the   place  of  alcohol    Very   fail'lv. 

'I'iie  chemical  composition  of  these  vegetable  principles,  and  the 
similarity  of  their  action  was  a  matter  which  did  not  escape  the  ob- 
servation of  IJebi^.  who  wrott — •'Theine  is  related,  in  composition, 
to  no  organic  nit ro^vni/ed  base  more  closely  than  to  kreatinine, 
that  remarkable  compound  produced  in  the  vital  process,  and  oc- 
curring in  the  muscular  system  of  animal.-:  and  to  irlvcocoll.  which 
we  ma  v  suppose  to  exist  in  gelatine,  coupled  with  another  compound, 
a-  mav  l>e  .-ecu  bv  the  fol lowing  formula: 

'  I '  i !  e  1 11  e .      . 

Kreatinine.      ..... 

<  i  lycocoll  (anhydrous). 

Kivatin.  ..... 

TheobromiiU',  (in  ( 'aeao  i, 

Tiiere  arc  no  drinks  wliicli  in  their  complexity  and  in  the  nature 
of  ceria  n  constituents  have  more  resemblance  with  soup  than  tea 
and  colTee;  and  it  i-  vepy  pro'iaMe  that  the  use  of  them  as  a  part  of 
fond  depends  on  the  exciting  and  vivifying  action  which  they  have 
in  com  n  10!  i  with  sou  p. 

Tln-re  are  .~otiie  discrepancies  betwixt  these  an<l  more  modern 
form  ilia-,  which  mav  or  mav  not  depi-nd  upon  the  MC\V  notation:  hut 
which  arc  of  comparative  unimportance  as  compared  with  the  main 
fact  uf  t  he  st  roni:  similarity  and  chemical  rc-emblaiice  which  exists 
between  t  hese  sub-tance--.  I  n  I'usn  MIS  <if  uic;it  and  ml'usiniis  of  cer- 
tain vegetable  prn  -  alike  contain  stimulant  mare]'-;,  whose 
properties  re-t  upon  the  larife  proport  \«\i  of  nitrogen  they  in  com- 
mon possess. 

These  vegetable  principles  are  used  largely  bv  race-  \\dio  do  not, 
take  a'.coiii.il.  The  A  rali  and  the  Turk,  forbidden  bv  their  religions 


STIMl   I. A  MS. 

to  taste  alcohol,  have  found  a  substitute  in  eoll'ee:  while  the  ah-te 
mious  ( 'hmamaii  lias  cultivated  t  he  Tea-plant.  The  total  abstainer 
of  Anii'ln-Saxon  descent  lias  adopted  the  drinks  of  the-e  races.  ••  1; 
is  true  that  thousands  ha\e  lived  without  a  k  nou  lcd-c  of  tea  or 
eolVee,  and  daily  experience  teaches  us  thai  under  en-tain  eircuni- 
stanccs.  thev  niav  lie  dispensed  with  without  disadvantage  to  the 
merely  animal  vital  functions.  l'>ut  it  is  an  error,  eertainlv  to  con- 
clude  from  this  that  tliev  niav  he  altogether  dispensed  with,  in  ivfcr- 
cnee  to  their  ell'ects;  and  it  is  a  (|iiestion  whether,  if  we  had  not  tea 
and  coll'ee,  the  popular  instinct  would  not  seek  for  and  discover  the 
means  of  replacing  them.  Science,  which  ueeuses  us  of  so  much  in 
this  respect,  will  have  in  the  first,  place,  to  ascertain  whether  it 
depends  on  sensual  and  sinful  inclinations  inerelv.  that  everv  people 
of  the  idobe  has  appi'opriated  some  such  means  of  acting  on  the 
nei'Vous  life.  -  from  the  shore  of  the  1'acilic.  where  the  Indian 
retires  from  life  for  a  few  davs.  in  order  to  nijov  the  Miss  of  intoxi- 
cation with  koka.  to  the  Arctic  regions,  where  Kamschatdales  and 
Koriakes  prepare  an  intoxicating  beverage  from  a  poisonous  mush- 
room. "  ( Licbiir.) 

Not  oiilv  is  there  a  widespread  instinct  for  "  these  means  of  act- 
ing <>n  the  nervous  life,"  as  Liebi^-  happily  phrases  it:  but  the  mn- 
sc(|iience  of  excessive  indulgence  is  seen  in  the  various  nervous 
affections  which  we  notoriously  associate  therewith. 

The  "  tea-drinker's,  heart  "  is  a  wcll-reco^nixed  maladv.  1'eople, 
especially  of  the  female  sex,  who  drink  largely  of  tea.  and  still  more 
when  thev  do  not  eat  a  suHicirlit  nuantitv  of  food,  sutler  from 
manv  nervous  troubles  as  well  as  palpitation  and  neuralgia;  and 
present  all  the  phenomena  of  nerve-exhaust  inn.  The  nurse  often 
drinks  tea  to  sustain  her  when  there  is  no  appetite  for  food,  until 
utter  exhaustion  is  the  untoward  result;  and  a  slate  IiorderJiiL1'  on 
the  delirium  trcmen.s  of  alcoholic  excess  is  re\ealed.  The  "  ten- 
dril nkard  "  is  a  wel  I -know  n  pal  mi  t  at  all  hospitals;  and  is  not  un- 
known in  private  practice.  "The  cup  which  dicer-  but  doc-  not 
inebriate  "  is  not  without  a  toxic  influence,  when  taken  to  excess. 

\\  1 1  ile  tea  is  in  almost   universal  use  with  the  A  n'_do-Sa  vn .  eoiV 
is   eijiiallv  in  \"oi;'iie  \\iih  the  (iernians.      They  ha\c  the  -anic    -,{<•'.  \<>\. 
to  a  u'real    extent.       ColTee.   however,   has  M    distinct    eiTecl    upon    I    !• 
heart:    and    call'eine   wit  h  a  formula  of  (  '  1 1     N<»    is  used  as  ;,  in-- 
cine  in  eases   of   cardiac   dehilitv.       \"  o'_;-e  1    has   advocated    I  he    u-~" 
st  ronu"  coll'ee   with   cream  as  a  tonic  and    food    in    the  dehi:  !\    u'ii 
attends  upon  acute  disease    in   children.       No  such  u-'e  of   tea  has  a- 


.">»'•  MANTAI.    OF    DIKTKTICS. 

vet  found  an  advocate.  Tea  contains  an  aromatic  oil  as  well  as 
tlicinc,  and  its  effects  upon  the  nervous  system — for  <n>od  or  evil — 
may  to  some  extent  lie  due  to  this  rather  than  the  theine. 

So  much  then  for  those  stimulant-  bodies  derived  from  the 
animal  and  vegetable  worlds  alike,  whose  properties  depend  upon 
the  nitrogen  contained  in  them. 

Alcohol.-  If  the  matter  of  beef  tea  is  difficult  of  discussion  in 
consequence  of  ignorance  and  prejudice,  how  much  more  diilicult  is 
it  to  handle  alcohol— a  matter  bristling  with  difficulties,  when  fhe 
pure  white  li^ht  of  truth  can  scarcely  be  seen  clear  of  the  coloured 
rays  around  it  ? 

Alcohol  has  a  formula  ('. ,II,.O  (better  known,  however,  by  the 
old  formula  (',11,0..!.  and  is  a  readilv  combustible  substance — out  of 
the  bodv.  A  verv  liu'ht.  volatile  bodv  it.  is.  hiu'hlv  inflammable. 
All  matters  which  arc  o\idi/ahle  in  the  bodv  are  "  foods '"  (Iler- 
niann).  Liebii^  held  the  opinion  that  ''Alcohol  stands  only  second 
to  fat  as  a  respiraforv  material  "  while  adding  "  Alcohol  and  alcoholic 
drinks  arc  from  their  price  most  costlv  materials  of  respiration. 
The  same  effect  could  be  produced  in  the  bodv  bv  means  of  saccha- 
rine and  farinaceous  art  ides  of  food  at  one-fourt  h  or  one- fifth  of  t  he. 
cost."  A  fierce  war.  embittered  bv  the  presence  of  sentiment,  has 
raided  around  the  matter  of  the  food-value  of  alcohol.  Readily 
combustible  out-ido  the  bodv.  some  have  denied  its  combust ibi I ity 
within  the  bodv.  Kit'tv  \vars  au'o,  the  most  advanced  chemists  be- 
lie veil  in  the  "  spontaneous  combust  ion  "  of  the  bodies  of  drunkards. 
In  that  thev  were  eertainlv  mistaken.  Then  came  the  recoil  of 
opinion.  Total  abstainers  are  ranked  in  battle  array  on  the  matter 
AVith  ot  her  observers.  The-e  last,  and  their  names  are  both  numer- 
ous and  weight  v,  hold  that  alcohol  is  larvvlv  burnt  in  the  body  by 
oxidation  and  is  therefore  a  ''fuel  food."  Personally,  after  very 
considerable  attention  (IP  the  subject,  1  must  sa  v  that  1  am  amoiiLT 
those  who  hold  "that  the  chief  portion  of  the  alcohol  injected,  un- 
dergoes consumption  in  the  bodv." 

P)iit  t  he  quest  ion  of  "  alcohol  ;i<  a  food"  can  never  be  separated 
or  divorced  from  that  of  "alcohol  ,-i-  ;i  stimulant:"  as  a  force- 
liberator.  Liebi^r  reco^ni/cd  tlnsa-peei  of  i  he  subject,  and  wrote  as 
follows: 

"The  use  of  spirit-  i-'  not  t  he  caii-c  but  an  elfeci  of  poverty.  It. 
is  an  except  ion  from  t  h''  rule  when  a  well-fed  man  becomes  a  s|)irit, 
drinker.  <  >n  the  other  hand,  wh"ii  the  laborer  earns  bv  his  work 
less  than  i>  required  t"  |>rovide  the  amount  of  food  which  is  indis- 


STIMULANTS.  ;,  7 

pensable  in  order  to  restore  t'uilv  ids  working  power,  an  un  vie!di!e_r. 
inexorable  law  or  necessity  compels  him  to  have  recourse  PI  .-p.rit-. 
He  must  work:  but  in  consequence  of  in-utlicieiit  fond,  a  certain 
portion  of  his  working  power  is  daily  wa-tin^.  Spirit-  bv  their 
action  on  the  nerves,  enable  him  to  make  up  the  deficient  po\\vr 
nt  Hit'  i  .>•/!!• //.-.->'  (//•'  ///>•  fin////,  to  con-unie  to-, lay  tha'  nuantitv  which 
oii^ht  naturally  to  have  been  employed  a  day  later.  lie  drau-.  -o 
to  sprak,  a  bill  on  Ins  health,  which  must  be  always  renewed  be- 
cause, for  want  of  means,  he  cannot  take  it  up:  he  coii-ume-  his 
capital  instead  of  his  interest;  and  the  result  is  the  inevitable  bank- 
ruptcy of  his  body.  " 

This  mat  ter  of  "  physiological  bankruptcy  "  made  a  deep  im  pivs- 
sion  upon  me  at  the  verv  threshold  of  mv  entrance  upon  medical 
pract  ice.  and  has  been  my  jjfuide  to  the  nsi-  of  alcoholic  .-t  i mu Ian*-  in 
the  treatment  of  disease.  If  much  alcohol  be  ^-jvc'i  without  other 
readily  oxidi/able  food-  while  fiirnishini:  a  certain  amount  of  iv-pi- 
ralorv  food  in  it  sell'— its  etTect  is  to  con- nine  t  he  body --tore:  in  ot  her 
wnrds  to  produce  "  physiological  bankruptcy."  Kspeciailv  i<  ibis 
matter  to  be  borne  in  mind  when  there  is  danger  of  the  system 
sinking  from  exhaustion.  There  is  a  deep-rooted  fear  in  mv  mind 
that  many  a  case  of  acute  disease  (and  especially  in  fevers  running 
a  certain  coitrse  of  so  many  dav-l  ha-  been  sent  into  "  a  iiraye  never 
'in'.:  by  nature"  (as  II.  ( '.  \\ood  pithily  puts  it)  by  over  stimula- 
tion: by  "physiological  bankruptcy."  (ither  hvdro-carbonace.,ns 
food  as  well  would  have  been  preferable;  and  the  di-piav-  of  energy 
e\oke>l  by  doses  of  alcohol,  were  a-  disastrous  a-  the  di-piavs  of 
wealth  manifc.-teil  by  a  reckless  youn^r  sipiire  who  raises  the  means 
for  them  by  mort u'au'cs  on  in-  proper!  \  :  each  ,lispla\'  rendering:  ii;m 
di.-t  inct  iv  poorer. 

'I'h  i.-  Lfn-at    cardinal    fact    that    .-!  imn  iai:t  -  a  re    "  force- liberator- ' 
mii-t  never  lie  forgotten  in  practice.      If   force   mn-t    be   >ei    free   to 

meet    some  emergency  t  lleU    alcohol       -Sllppi  VillLT   so  111  e    fol'i-e    ill   l!-*i 

we,!  a-  liberal  MIL;'  other   force-    mav  I"-    ui'^entix  called   for:    but  tiic 
aftereir-'ct    mi;-!    not   be  left  out    of   i  he  caiculat  ion.       In  -vncnpe    M 

ci  i!id it  ions  of  acut e  e\han-t  ion  fret.'  resort   to  alci  ihol  ma \  be  •  i n .  \ 

IIP  an-  a!    hand;    aii'i    ma\'  lie,   too.   i;    lieenme-    nci-e<sarv  to  •_  \ 

lill-l    Illed     ijliailtities     to     tide     over     the     ini!l|ed:a!e     d.'i'i'je";      ; 

uho:.'  of  it-  operation  mn-t   be  borne  m  mind  all  the  -ame. 

A-  to  t  lie    '•  f b  value  "   of   alcohol    in    h-nl;  hit: 

imi  on  i  he   -:cr\  m;-    -\  -;i-m.       I .  • 


5*  MAM'AL   OF    DIKTKTICS. 

lent  of  a  fair  meal  in  alcohol,  lie  would  lie  dead  drunk.  If  lie  took 
it  comparatively  quickly-  -as  when  men.  for  wafers,  drink  so  much 
spirits  in  a  limited  time — the  strong  probability  is.  he  would  in  a 
very  short  time  sink  into  eoma;  which  ere  loni:  would  deepen  into 
death.  Its  "food-value"  in  health  is  such  that  its  eonsideration 
need  not  enirauv  our  attention  for  IOIILJ. 

Rut  in  ill  health  and  especially  in  acute  disease  the  question  of 
its  "food-value"  as  well  as  its  value  as  a  "stimulant."  mav  well 
engage  our  attention  at  some  length.  As  well  as  a  force-liberator 
it  has  some  value  as  a  "  fuel-food."  Indeed,  at  times,  dilute  alcohol 
is  all  that  the  patient  can  take,  or  the  stomach  retain.  Alcohol 
requires  no  digestion;  let  that  fact  be  kept  in  view.  By  its  ready 
divisibility  it  quickly  passes  bv  osmosis  from  the  stomach  into  the 
blood.  When  the  digestive  powers  are  seriously  enfeebled  this 

matte]-  IK mi's  very  important.  Alcohol  provides  some  force,  and. 

borrows  some  from  the  system.  How  far  can  the  borrowing  u'o  on? 
That  becomes  the  question.  It  mav  be  possible  to  provide  the  alco- 
hol m  unlimited  quantities;  but  is  the  store  of  body  force  illimita- 
ble;' That  is  where  the  shoe  pinches.  Whenever  possible  or 
practicable  the  alcohol  should  be  accompanied  by  some  soluble 
carbo-hydrates,  which  would  supply  the  place  of  the  borrowed  force. 
Say  with  some  Malt  Kxtract  diluted;  that  would  be  a  capital  com- 
bination; or  in  milk,  excellent.  Or  with  lemonade,  home  made, 
containing  a  distinct  amount  of  soluble  suirar.  The  neglect  of  this 
matter  is  fraught  with  disaster.  This  will  be  further  considered 
when  the  treatment  of  exhaustion  comes  to  be  discussed. 

The  ejfect  of  alcohol  is  to  produce  increased  action  in  the  heart, 
while  the  carotid  arteries  are  dilated,  and  so  the  brain  is  Hushed 
with  blond.  This  flooding  of  the  posterior  cerebral  lobes  produces 
a  sense  of  well-being.  /./-.,  the  patient  feels  better  for  the  time;  no 
doubt,  too.  the  alcohol  borne  aio]|M-  m  |j1(.  Mood  acts  directly  upon 
the  cerebral  cells.  I'robablv  a  like  continued  ell'ect  of  increased 
blood  supply  and  direct  stimulation  goes  on  in  all  part-  of  the  ner- 
vous system — the  organic  or  sympathetic  as  well  as  t  lie  < ercbro- 
spina'i.  Hut  this  ell'ect  is  temporary  and  evanescent.  Such  st  imu- 
lat  ion  carries  wit  h  it  t  he  after  ell'ect  of  exhaust  ion.  The  heart  ila^s, 
the  carotids  contract  below  their  normal  calibre  and  the  brain  be- 
comes bloodies-.  If  this  lead  to  sleep,  as  often  happens,  then  the 
alcohol  mav  have  been  advantageous  in  everyway.  P>nt  the  tem- 
porary tune  of  stimulation  ou-j'ht  to  be  utdi/ed  to  assimilate  some 
easily  digestible  food.  <  M  her\vi-c.  \\  mav  ha\e  been  useless:  av. 


STIMI  I.ANTS.  ;,:• 

wor-^e    than    useless.      Kin^  ('handlers   says  wisely  of  a'.. -oh"':   ' 
the  alcoholic   dnnk   be    limited  to  that    i|iiant:t\    \\hich  in^rea —  :;,. 
appetite."      lie    is   at  the   time   speak  in;:  of   its  use    in    lii-art   :' 
Hut  the  principle  is  a  irood    one  to    hold  to  under  ail    eip-um-i  a  »:•/>;•«, 

Alcohol  is   a    two-edircd  tool,  not   to    In-    used  without    iv;V.-T  on; 
and.  like  any  other  tool,  all  the  more  skilfully  u-ed  from  fan:'!;;'!-  tv 
with    it.      Sometimes    it    is  withheld    when  the  call  for  '.\    i      i.rj-eM. 
At    other  t  inies  it    is  pushed  recklessly,  and    alcoholic    L.r:t-tr:t  i- 
up:   the   stomach    rejecting   it    (jiiieklv,  while  the  tongue  is   p-d    :(!,. 
irritable,  and    the   bowels    tilled    with  tlatus.      This   condition    i 
duced    whe;i    alcohol,  commonly  in  the  form    of   hrandv.  is   ^iyeii  in 
considerable  ijtiaiit  it  ics.  insuiTicieiitly  tliluted.  and  at    frequent  inter- 
vals.      Here  Nature    is   stepping  in  to  limit    that    stimulation    which 
is  thi'ea tenin^   the  existence  of   the  organism  —  when   exhaustion    ; 
close  at   hand,  and  "  the  beat  MIL;'  of  t  he  w  HILTS  of  the  A  iiLi'el  of  I  'eat  li 
are  di-tiiictlv  audible  overhead.'' 

This  condition   of  exhaustion  is  specially  liable  to  come  on  when 
alcohol,  alternately  with  beef  tea.  is  alone  LTIVII  to  the  patient,     lleef 
tea  which  (as  ordinarily  made)  is  no  food:  alcohol  which    i-  a  food. 
carrying  with   it  a  ht-avv  borrowing  power!     No   wonder   the  system 
is  in   danger  of  sinking   from   exhaustion.      Ail    that    has   been   >a;d 
here  applies  to  acute  coiidit iolis.  as  fevers,  and  also  to  conditions  nm 
exactly  acute,  as   in  ilropsy  with    a    failing    heart:   or  in  acute  eo:,. 
tions  implanted  upon  a  chronic  state,  as  in  an  acute  bronchial  attack 
in  a  person  the  subject  of  chronic  bronchitis.       Here  we  \\i-h  to  -u-- 
tain  the   powers,  and    for   that  end  we  use  alcohol.      Hut  we  mu-t  .-" 
use  it    in   combination  with  soluble  carbo-hydrates  that    we  do   not 
make  it  a  mean.-  of  sinking  the  ship.       If   it  be  ;_ri\en  al-'iiir  with,  or 
alternately   with,    a   meat    broth   containing  some    baked    Hour,  v, 
milk,  or  diluted  malt  extract,  then  the   power  niav  lie  stistainei'i 
the  strength    be    kept    up  or    maintained.       Hut    when    aieoh"!    : 
is  ad m mistei'ed   experience  has  told  us   in   unmistakable  accent-  tuo 
end  i-  not   far  oil'. 

\\"c  are  told  "  to  u -c  t  he  p;ood  1  hii'iTs  of  this  \\-orld  a-  not  abn-'1 
them:"   and    to   do    this  with  alcohol    is    ••    feat  of   judgment.       !'.: 
conies  the  rcijii  i-it  e  k  now  led  L:''-:   then  t  he  judu'iiient   t"  n--1  t  ::••  !\  -.- 
ed'^c  ariLfht.       In  tini'-s  of  acute  depression  alcohoi    :-  of  in.-; 
value.       lint   then  the  end   mu-t    be  kept   \\ell   in  \  iew.       At;: 
cour-e  mii-t  not    be   indetiiiite;   must    not    indeed    be  pp.  '••. 
|)rtip"rt  ion    as    it    can    'he   combined  \\nh   other   fm»i    r  \\ 
continued.      \\u{    when    it    alone   can    be    taken  the   end 


<><>  MANUAL    OF    D1KTKTICS 

measurable  distance.      So   much    for  alcohol  as  at  once  a  food  and  ;i 
st  iinulaiit  -    a  "  force  liberator.  " 

\\lieii  the  subject  of  malt  liquors  comes  before  us.  then  no  ono 
can  dispute,  or  think  of  d  is  put  MIL;'  1  he  food  value  of  the  maltose  con- 
tained therein.  In  the  brewing  process  a  certain  quantity  of  mal- 
tose is  broken  up  into  alcohol  and  carbonic  acid :  while  a  distinct 
proportion  remains  unchanged.  Consequently  the  well-fed  navvy 
who  prefers  to  do  the  1  st  hour's  work  of  his  laborious  dav  on  a  pint 
of  ijood  sound  ale.  has  a  hard  solid  argument  on  his  side.  Having 
expounded  mv  own  views  at  some  length  and  as  judiciously  weighed 
the  subject  as  in  mv  power  lies,  some  reference  may  be  made  to  \\lia 
ot  her  men  have  thought  and  written  on  this  dillicult  and  complex 
subject.  Hrinton  in  "  Food  and  its  I  h^vst  ion  "  aftei-  v,oniLr  over  the 
pro-  and  cons,  wrote-  a f ter  ^ivinu;  the  obvious  drawbacks  of  alcoholic, 
indulgence  and  how  it  blunts  alike  the  menial  edire  and  the  deli- 
eacy  of  touch  and  movement : 

"  (  hi  the  other  hand,  however,  it  is  necessary  to  remember  how 
often  the  whole  quest  ion  must  practically  be  approached  from  a  totally 
different  aspect:  how  often  alcohol  constitutes  not  the  single  feather 
which  distracts  the  sleepy  savage,  but  the  bed  of  down  which  restores 
the  exhausted  man.  It  may  disturb  a  balance  exquisitely  adjusted; 
and  yet,  in  the  main,  counterpoise  a.  scale  heavily  laden  with  disad- 
vantages. If  alcohol  exhilarates,  imparts  comfort  and  energy,  coun- 
teracts fatigue,  hunger  and  unrest,  then  it  does  in  eiTeet.  increase 
the  capacity  for  work  of  those  who  take  it  under  such  circumstances; 
and  atl'ords.  in  so  far.  a  direct  heiielit  and  ad  vantage. " 

I  'av  v  says  of  it  as  a  food :  "  From  a  review  of  the  evidence  as  it  at 
pre-'i-iit  stands,  it  may  reasonably  he  inferred  that  there  is  sullicient 
before  us  to  justify  the  conclusion  that  the  main  portion  of  the 
alcohol  invested,  becomes  dc.-i  roved  within  the  system,  and.  if  this 
be  the  case,  it  inav  fairl\  he  assumed  that  the  destruction  [.-attended 
with  oxidation  and  a  corresponding  liberation  of  force;  unless, 
indeed,  it  should  undergo  metamorphosis  into  a  principle  to  be 
temporarily  retained,  but  nevertheless  ultimately  applied  to  force- 
pr<  idiict  ion.  " 

KinLf  Chandler-  sums  up  his  consideration  of  a  icoliol  so:  "  — (A). 
Let  it  be  taken  never  as  a  stimulant  or  preparative  for  work,  but  as 
a  defence  airai list  t  he  injury  done  by  work,  whet  her  of  mind  or  body. 
For  example:  it  is  best  taken  with  the  evening  meal,  or  after  toil. 

(|',i.  Let  the  increase  in  the  desire  for  and  power  of  di^e-tin^ 
fond  be  the  inude  and  limit  to  the  consumption  of  all  alcoholic; 


STIMl   I. A. NTS.  •'.  1 

((').      Let    the    forms    he   siidi  a-  con;  a  i  n  the    lea-; 

fllSel    Oil. 

(IM.      Let  all   with  an   hereditary  tendi-n  •'.'  t"   h\-teria 
functional   disease  of  the   nervous  svstetn.  refrain  from    it- 

<ret  her.  even    though    as    vet    tlievare    iii    -• i    health.       Ainoi- 

hereditary  tendencies  must  he  clas>ed  a  procli\  it  \  to  .ie .  iirht  in  dn;nk- 
cnness.    which    reinarkahly    runs    in    families.      Children    with    - 
an  heirloom  had    hest    In-  kept  to  as   late  an  a  ire  as    po— liile  w.:':.- 
last  inir  st  rone-  ilrink.  " 

Indeed,  there  can    In1  no  question  ahotit    tin-  desirah;i;tv  of  \\ 
holding  alcohol  from   children  under  all   circumstances  hut    tho-e,,;' 
din-  necessity.       It  is  an  injury  to  a  eh; id,  to  sulijeet   its  t  ,--ue-  ;o  ;  ;..- 
action  of  alcohol.      (  diildrcii  are  in  many  respects  like  inferior  ra-e-. 
And  of  these  Sir  William  K'ohert-  writes:     -"  There  are  certain    ' 
nor  race-  who  appear  to  he  altogether  intolerant  of  alcohol.      L  ti;ei- 
it  does  not  suit  their  tvpc  of   nutrition,  or  thev  lack  the   -elf-con;  r. 
which    is    necessary    to    its    henelicial    use.      The    Indians    of     North 
America    are    said    to    he   excited    almost    to    mad  lies-1.   !,\   an\    ii-e    of 
alcohol,  insomuch  that  the  Colonial   authorities  i'orh    !.  under  la-a1,  v 
jienalties.    the    i_riviiiL;   or   selling"   "f   alcoholic    liquors    to    tiie    nali\'- 
ti'ihis.      The  Ailios  of  Ye/.o.  a  stihjeci   mee  inlialiitiKir   the  \o'";:, 
island  of  .Japan,  appear  to    he  wholly  wanting  in  self-cont  mi    in    ;  he 
use   of  alcoholic   stimulants,  for  which   the\  evince  an    irrepre-- 
pas.-ion.      Whenever   they  have   the  opport  unity,  lioth    the   men   and 
women  drink    themselves   to  ;i  state  of   inseiisihilit v.      The  defect 
reaction  of  these  races   towards   alcohol  mav  he  compared    to  a  -inn- 
larh"  defect ive    reaction    in  certain    individuals   and    certain    fam;.: 
ainoi!',;'  on rselyes.  "  : 

()n  the  other   hand,  just    as  strong   men    usually  tolerate  ale. 
Weil,  so  apparently  do  the  stronger  races  of  mankiini.       Kin::  Chan  - 
her-  writes:      "Ail  nations  that    ha\e    leil    the  van    in    the    march    . 
civ  ill/at  ion  have  I  icen  addicted  to  drink.      a\ .  and  add  let  ed  to  ijr:;:,.-\- 
eiine-s.      The   .lews,    the    (i recks,    the     Ii'oinans.    the   lierman-.    ; 
Swi'd.es.  the  I>anc.— -not   to  mention  the   l'in-'!;-ii  all  round  the- 
are  amply  atte-ted    h\-  their  own    native    literature  to   ha\c  hee] 
i  i  IILI'U  i-hed  aliove   their  contemporaries    in    tin-  wa\.       1' 
some  react  ionary  races,  famous  as  coniiuei-o!'-.  ha\e    !.ee'    a;  - 


•  •I'  MAM'AI,    OF    IHKTKT1CS. 

but  they  ami  their  t'aitlis  arc  ilyinir  out.  ami  the  coloring  they  have 
Driven  tn  civilisation  iscvcn  iio\v  fainter  I  han  that  left  l>y  'he  minister 
races  a  thousand  Years  before  t  hcv  were  heard  of."  \\hiie  Maudsley 
ha-  pointed  inn  that  drunkards  in  socict  Y  are  like  t  lie  waste-heaps 
of  nianut'aeturiim  industries  thcv  are  so  nianv  \vitnesscs  ot  the  in- 
tellectual activitv  ^oinL:  on  around  tlieiu.  The  stronger  the  ra<-e, 
the  greater  their  enjoviueiit,  of  that  exaltation  which  alcohol  pro- 
duces. As  Burns  savs: — 

John  r.arlevcorn  was  a  licro  bold, 

( if  noble  enterprise; 
Fur  il'  YOU  do  but  taste  bis  Mood. 

"T  will  inako  your  couraii'i1  ri^e. 

"!'  will  make  a  man  forget  bi^  woe: 

'T  \\  ill  hei-'lileii  all  liis  ji  >y; 
'T  will  make  the  widow's  lieai'1  1o  sinu', 

'rboii^'li  tin;  tear  were  in  liei1  eye." 

This  etVect  it  is  which  constitutes  the  danger  of  alcohol;  ;nid  if 
the  delight  in  sncli  excitement  cannot  be  kept  within  strict  bounds, 
the  downward  career  of  alcoholic  excess  ending  in  drunkenness  and 
degradation,  is  apt  to  beset  on  foot. 

In  concluding  his  contribution  to  "  Tho  Alcohol  (^ue-tion." 
which  was  discussed  in  the  "  Contemporary  Review, '"'some  fc\v  years 
:iU'(>.  I 'r.  Sam.  \Vilks  said: — "  In  jud^in^  of  the  use  of  alcohol  by 
the  ciiiiininnit v  at  lar^'e.  \ve  mii-t  lie  guided  in  the  same  uav  as  we 
are  hvother  habitsof  mankind.  \VeseepersonsenjoYinLrtheinselves 
in  various  wavs.  eat  HILT  and  drinking  all  kinds  of  food  and  beveraires. 
occnpvin'_r  theuise!\cs  with  a  in  i  tsciiie;  1 1  s  of  cYei'Y  description,  and 
yet  none  of  t liest-  \voiilil  be  allowed  in  Vtopia.  Thev  ^i-t  thnm^h 
the  \\'orld.  althoiiLr'h  indulLi'iliU'  in  certain  haluts.  and  declare  them- 
selves well—  where,  then,  is  the  appeal  against  their  procedure?  If 
I.  personallY.  am  consulted  as  to  the  proprietv  of  ordering  alcohol 
in  any  individual  case,  if  there  be  no  experience  to  ^uide  me,  I 
am  impelled  bv  the  principle-  I  have  enunciated.  I  believe  alcohol 
soothes  a  worried  nervous  svstem.  and  bv  prevent  MIL:'  wear  and 
tear,  actuallv  -upports  the  frame;  bul.  discarding  the  notion  of  its 
st  iniuialinir  proper!  ies.  I  denounce  its  use  in  delicate  children  and 
in  women  who  fee]  'low.'  I  also  .-trough-  prohibit  its  use  in  the 
carlv  moj-nin^:  in  lact.  those  who  then  wish  for  it.  have  aln-adv 

imbibed     too     lllllch.         I     alwaVS     SllSpect      people     who     I'e'plirc     ' 

tiling  '  about   eleven    in    the    morn  mi:.       Indeed,  the   man  or  won  ia 


STI.MI  LAMS.  .;:; 

who  has  tin  aonte  cnnsciousiH'ss  of  the  hour  of  eleven  is  a  !,.•:• 
phvsically  and  niorallv  lost." 

No  doul)t  there  is  much    truth  tis  well  a-  force  in  the-.-    p-ma 
and  there  tire  two   mutters  connected  with  alcohol,  well  worth  bear- 
ing in  mind:- 

1.    Xever  luive  tileoho!  in  the  brain  when  it   lias  work  lo  do; 

'.'.     A    little  tlleohol    betwixt    ;i    lli:ill   tllli  1    ;i     pa-t     trouble,    is     henni-- 

silile:    but  it  is  not  well  to  put  a  little  tueolioi  in    front    of  a   eominir 
trouble. 

I  may  fitly  conclude  this  chapter  hv  a  quotation  from  the  late 
I  >r.  Murehison.  whose  hook  on  Fevers  is  so  favourabiv  known  everv- 
\vhere:  — 

"  What  then  are  the  conditions  of  the  annual  economv  in  which 
alcohol  mav  he  of  positive  use?  That  there  are  such  eond!;;on~  I 
helieve  cannot  lie  denied  hv  anyone  who  has  honestlv  studied  the 
snliject:  hut  thev  tire  not  the  conditions  of  perfect  hcaith.  !;  :- 
espeeitillv  u'lii'ii  the  circulation  is  weak  or  siuv;v;ish,  that  a  dailv 
allowance  of  alcohol  mav  do  ^ood.  'I'iius 

"  1.  Alcohol  is  useful  iii  the  cniir.-e  of  most  acute  diseases,  when 
the  orpins  of  circulation  lie-in  to  fail,  a-  they  are  apt  to  do.  A 
moderate  (plant  ity  usually  sulliccs.  The  Sar^e  quantity  './/..one 
or  t  wo  hott  les  of  hrandv  in  twcntv-four  hour-  -till  sometimes  ad- 
ministered, nitiv  do  htirm  hv  inducing'  congestion  of  \arious  internal 
orpins. 

"  ','.  In  convalescence  from  acute  diseases,  or  from  other  weaken- 
ing ailments,  when  the  circulation  remains  t'eehle  and  the  tempera- 
ture is  often  subnormal,  alcohol  is  also  useful  in  promoting:'  i  he  cir- 
euhition  and  assistini;'  di^e>tion. 

"  '•'>.  In  persons  of  advaneeil  life  t  lie  ciren  hit  ion  is  also  often  feeble, 
and  a  moderate  allowance  of  alcohol  often  appears  to  lie  beneficial. 

"  All  other  conditions  of  the  svstcin  marked  by  weakne.--  of  the 
muscular  wall  of  the  heart,  whether  permanent  or  tran.-ient,  are 
usually  benefited  l>v  alcohol. '' 

Alcohol  is"ap)od  .-ervant.  but  a  !>ad  master." 

The  charge    brought    against    the   medical    profession,  that    much 
alcoholic  excess  take-  its  origin  in  medical  ad\  ice      ;s  a  i-iiai'^ 
preferred.      It   is  undoubtedlv  often    made   the  e\cn-e  |p.r   •  ','. 

1  eertainlv  t hink  (lie  u't'catest  caution  ,-hould  be  e\erci 
of  neurotic  women   and    their  children,  u  here   there 
ni'_r  for  alcohol,  and  the  haliit   i-  uio.-t  ea>i!v  tieipi.r' 
lllll-t    never  forget    Its   possible  abu.-e. 


CHAPTER   VII. 


Tin:  type  of  "  Fluid  Food"  is  Milk — the  food  Xature  provides 
for  all  young  mammalians.  It  is  a  complete'  and  perfect  food,  con- 
tainitig  fat  (in  an  emulsionised  form.)  albiuuen,  (in  the  form  of 
casein.)  carbo-hydrates,  (as  milk-sugar.)  with  salts,  (phosphates  and 
others. )  all  properly  diluted.  On  this  food  life  can  "be.  sustained  for 
an  hidefmite  period.  In  sicktiess.  milk  is  really  our  sheet-anchor. 
Hut  there  is  one  matter  to  be  borne  in  mind,  and  that  is  this — milk 
curdles  as  the  first  step  in  its  digestion.  The  light  ctml  usually 
readily  re-dissolves  in  the  alimentary  canal;  but  sometimes  it  does 
7iot.  Fsprciallv  is  this  firm  curdling  liable  to  occur  where  there  is 
acidity  present  in  the  digestive  tract.  The  hard,  linn  curd  is  an 
irritant  to  the  whole  intestinal  surface:  and  in  conditions  of  ulcera- 
tion,  either  tuberculous  or  that  set  up  in  enteric  fever,  hard  pieces 
of  curd  may  rupture,  or  perforate  the  weakened  bowel.  The  pieces 
of  curd  7iiay  be  seen  in  the  stools.  When  such  is  the  case  the  milk 
must  be  combined  with  means  which  will  prevent  this  hard  curd 
forming.  At  times  it  is  well  to  stir  some  biscuit  powder  into  the 
milk,  which  mechanically  prevents  too  firm  a  cui'd;  or  where  ob- 
vious acidity  is  present,  some  light  carbonate  of  magnesia,  which  acts 
ill  two  wavs.  First  of  all  it  chemically  neutralizes  the  aciditv:  next 
the  carbonic  acid  gas  given  oil'  tends  to  disintegrate  the  curd  and 
break  it  up.  Milk  is  commonly  given  with  lime  water:  but  this  is 
often  too  feebly  alkaline,  and  magnesia  or  prepared  chalk  must  be 
used.  Usually  as  much  as  will  lie  on  a  sixpence  (or  its  U.  S.  A. 
equivalent)  to  the  halt  pint  of  milk  is  enough:  or  it  may  be  iriven 
with  a  mineral  water  as  Selt/.er  water,  especially  where  the  thir.-l  is 
considerable.  At  other  times  it  is  well  to  combine  it  with  such 
waters  as  Yiehv.  Yals,  Marienbad:  and  in  some  conditions  of  lithiasis 
such  combination  mav  be  freely  drank. 

At  other  times  some  malt  extract  well  diluted  may  be  added  to 
the  milk  with  advantage.  This  last  is  indicated  in  those  eases 
where  the  patient  feels  the  long  fast  betwixt  going  to  bed  and  risiu-j. 
or  either  betwixt  the  usual  hour-  of  bedtime  and  of  rising:  and 


something  is  desirable  in  the  small  hour-:  of  the  morn'mir.  A  :  ,'•>'.<•- 
spoonful  of  malt  extract  to  half  a  pint  of  warm  milk  in  a  h"i-\\a'er 
ju<_r  (\vitli  a  liil)  ]Mit  on  a  piece  of  wood,  or  other  non-conductor  ..:' 
heal,  and  covered  with  a  tea  eosev  (the  bigger  and  thick. •]•  ;h, 
better),  will  be  found  a  pleasant,  palatable,  and  nutritious  drink. 
The  tea  cosey  will  retain  the  heat. 

Then    at   other   times    milk    is   boiled    with   a   little    ground    r:  • 
flavoured  with  cinnamon:  and  this  is  an  excellent  food  when  tin-re  is 
anv  looseness  of  the  bowels. 

Skim-milk  is  an  excellent  beverage  in  pvrexial  state-,  where  fre-h 
milk  is  too  heavy.  Buttermilk  with  its  laetie  acid  is  a  irood  hever- 
iiiTe  where  there  is  much  thirst  and  in  diabetes. 

Milk    is  sometimes   too   cloying  and    is   preferred  in  the   form  of 

•whev.      \\diev   is  a   pleasant   stimulant    drink-f 1.      It    is   made  by 

adding  one  or  two  wineglassfuls  of  sherrv  to  half  a  pint  of  hot  milk: 
the  curd  is  strained  out  by  a  sieve.  It  is  not  in  fa-hion  at  present: 
but  its  day  will  come  again.  The  milk-sugar  in  it  u'lves  it  a  certain 
food  value. 

Then  there  are  certain  pleasant  drinks  with  a  low  food  value, 
good  in  fevers,  as  apple-water,  and  tamarind  water.  They  are 
pleasant  to  the  taste.  A  favorite  drink  is  lemonade.  The  rind 
should  bo  thinly  pared  (to  get  out  the  essential  oil)  and  the  lemon 
be  cut  into  slices,  put  into  a  jug  and  hot  water  ho  poured  in.  Then 
some  sugar  should  be  added  or  if  this  he  apt  to  turn  sour  in  the 
stomach  some  malt  extract  may  be  used  instead  of  cane  snirar.  Such 
lemonade  is  grateful  and  nutritive:  especially  when  made  with  ma'; 
extract  or  with  Mellin's  Koed.:;: 

Then  as  a  '"'drink-food."'  oatmeal  wafer  is  capita!  where  persons 
are  exposed  to  a  high  temperature  as  stokers,  iron-workers  and  the 
like. 

llarlev  water  is  a  pleasant  nutritive  drink,  and  a  capital  vehicle 
for  bitartrate  of  potash.  I'otn-  Impcrialis  sweetened  is  a  capita! 
beverage,  ^ood  in  a  cold  with  a  deposit  of  pink  lithatc-. 

Rico  water  is  a  drink  in  vogue  m  India.       It   is  a  nutritive   drink. 
-   and    thereby  hangs   a    tale.      When    ('live    was    besieged    in    Are 
provisions   ran    very   short.      There    were   ;i    few    Knu'iidinicn    a:.< 
nn  in  her  of  Sepi  iys.      This  is  Macau  lav's  account  of  what  ha  '  •!  «•::<  • ; : 

1 1   is  invidious  t (>  n K 'Hi  ion  nann  ••>  in  coin  if.  t  ion  with  food-.  I > 
iin  lias  liei'n  >nch  a    pioiii'i-r.  tli;it   lii-^    I'm  id  ni;i\    he  >|ioken    el    a-  ;ii.'  i\ 
a  niesl   1 1 ^et'id  d;i<s  of  foods  and  as  such  it   N  sjioki-n  ol'  I  rei|in  nt  iy.      I  '<  •_• 
his  food  Mr.  Mt'Ilin  is  unkowti  to  nn-. 


»>i>  MANUAL    OK    niKTKTlCS. 

"Tin1  Sopors  came  to  ('live,  not  to  complain  of  their  scanty  furo, 
but  to  propose  that  all  the  irrain  shouM  be  ^iven  to  the  Kuropwins, 
who  required  niorr  nourishment  than  the  natives  of  Asia.  The  thin 
U'rucl,  thev  said,  whu-h  was  strained  away  tVom  the  rice  would  suffice 
for  themselves.  Ilistorv  contains  no  more  touching  instance  of 
military  lidelitv.  or  of  the  inihn-nce  of  a  commanding  mind."  Lit- 
erature eontains  no  more  striking  instance  of  a  man,  accurate  bv 
habit,  tripping  e^repously.  Those  \vho  understand  the  matter 
thoroughly  assure  me  that  the  men  who  were  satisfied  with  "the, 
thin  irrnel  "  ijot  much  the  best  of  the  bargain. 

liicc  water  may  be  flavoured  by  any  vegetable  juice  as  that  of  the 
currant,  raspberry,  apple,  and  mulberry.  \\here  there  is  j^reat 
thirst  in  pyrexia.  such  drinks  supply  all  that  is  required.  In  phthisis 
however,  it  is  desirable  to  increase  the  food  value  of  the  drink,  and 
this  can  be  done  by  the  addition  of  a  mail  extract,  or  soluble  malt 
preparation  like  Mellin's. 

live  which  has  been  malted  forms  a  capital  addition  to  meat- 
broths,  as  the  stardi  has  largely  been  rendered  soluble. 

1  >e\t ro-saccharin.  (?)or  commercial  irrape  sugar,  prepared  for 
the  brewer,  can  also  be  utilised  to  gi\e  food  value  to  drinks — 
whether  meat-broths,  or  made  with  vegetable  material,  as  apple- 
water. 

Meat  Broths.  —  Beef.  veal,  mutton,  rabbit,  and  chicken,  aro 
the  materials  mainly  employed  for  the  preparation  (,f  meat  tea.  In 
the  last  chapter  it  is  to  be  hoped  thai  the  brains  have  been  knocked 
out  of  the  superstition  that  beef  tea.  or  any  other  meat  tea.  as  ordi- 
narily made,  is  a  fond.  The  addition  of  ihe  albumen  of  tlieiucat- 
libre  is  required  to  give  it  a  true  food  value,  if  that  were  done,  the 
amount  or  bulk  of  water  to  the  pound  of  meat  might  be  largely  in- 
nvased.  Then  too.  a  certain  amount  of  salt  should  be  added.  In 
invalid  cookery  there  is  a  decided  neglect  of  salt.  Liehi'_:'  advocated 
the  use  of  meat  extracts.  He  deplored  thcAvaste  that  went  on  in 
the  lar'je  hordes  of  cattle  on  the  plains  uf  South  America  and 
Australia,  where  thousands  of  oxen  were  annually  slaughtered  for 
their  hides  and  tallow;  and  suggested  the  preparation  of  concen- 
trated meat-extracts  from  the  lle-h.  lint  Liebi^-  himself  was  the 
tirsi  to  recogni/c  t  hat  such  meat-extracts  \veiva  "mean- of  invi^ora- 
tion."  rather  than  a  food.  There  arc  present  the  pleasant  salts  of 
muscular  t issue  and  the  stimulant  krcatin.  which  tempts  the  savage 
to  eat  his  vanquished  adversary  but  nothing  that  is  true  food. 

Ileef.  or   meat    teas   as  ordinarily   made,   and    Liebi^'s   meat  ex- 


tracts  stand   on   the   same   j>l;it  form :    thev   an-   not  pr;i'-t  i'-allv  :'<>• 
But  thev  arc  excellent  vehicles  for  soluble  earho-livdrate-;  a:.d 
the  combination  is  a  food      a  pleasant,  nutritive,  di;_'e.-t:h!e  I'm 

And  at  this  point   I   fee!  inclined  t<>  he  dogmatic,  e\eti  inure  th: 
iisiiai:    unnecossardv  so,  perhaps   tin-   hostile   critic    \v:l!    sav:    'MI: 
must  lie  done.      "Whole  hccf  tea,"  tliat    is— heef   t'-a    t<>    whi'-h    tL> 
meat    tihre    lias  been    restored    after    pounding,  is    no   doubt   a    ^.".; 
food.      Ycrv  <rood,  nodoulit,  in    convalescence    from   acute 
where    wasted    muscular    tissue    has    to    lie    repaired.       I'.ut    in    such 
patients  as  I  have  constantly  under  eaiv  at    the  hospital--,  as  phth:-: 
eal  patients  either  of  ehroiiic  character,  «-i   \vith    liectic  in  softeiiiv.i: 
tubercle,  or  chronic  bronchitis,  or  pleuritic  elTusions.  and  in  cardiac 
cases,  valvular  lesions   or   weakened   walls, — cases   seen    in    picntvof 
persons   outside    hospitals — it    is   open    to   question    whether   so    verv 
much  alhiiin inous   matter  is  cither  Lrood  or  desirable.      The  heef   tea 
miiiht    he   verv  much  weaker  and   he   flavoured  with   -ait.  and    some 
soluble  carbo-hydrate  added.      If   the  reader   will  at  this  point  make 
personal  trial  of  what  is  heiiiLr  said — (an  excellent  practice  with  anv- 
thinir  —  food  or  niediciiu  —  that    has   to    pass    the    palate)— it    wi',1 
well:  and  will   make  the  matter   perfect  Iv  clear.      Add  a  teaspooiifiil 
of  anv  haked    flour,  of   which    l,';il^e'<    food  is  a  tvpe,  to  a  teaciipful 
of  onlinarv  lieef  tea,  and  tln-n  add  some  salt:    first  look  ;i;  the  invit- 
ing soup  so   [d'odueeil— that  i- an  appeal    to  one   special   sense,  the 
eye:   then  taste— an  appeal  to  the  gustatory  nerve.      A-  to  it-  palata- 
hleiiess  it.  is  unnecessary  here  to  speak.      Hut    for   the   reader   who  ;s 
content    to    read  and  not    to    taste   and  try.  he  or   she    mav  take    mv 
woi-'i    for  it.      Well-haked    flour  is  larp'ly  changed    into  soluble  d 
trine;   ami  beef  tea  containini:'  some  such  addition,   is  a  capita!   f»od. 
If   the    flour  be  made  from  uiiliolted  Hour.   I,,-.,  where  the    bran    :;;i- 
not    been   removed,  then  some  albuminoid  matter  is  present    a-   wel 
as  the  .-alts  of  the  ii'ram.      Such  will  make  an  idea!  fluid-food. 

The  steam-cooked  cereals,  of  which    there  are  s<>   manv  varieties 
pi-oduced,    by  ditVercnt    makers   in    the    !'.   S.    A.,    arc  admirable    for 
addition    to    meat    broths.      1'lain    biscuits    powdered    arc   a'.-o   •_,,<•':. 
The    ('haiinel     Islandei's    alwavs   add    limken    biscuit    to   their    •••u:'-. 
and    thus   ^ivc   them  a   hiu'h    food    value.      Soups  are    indeed    : 
lietterfor  such  addit  ion.  no   matter   whether  made  of  -to.-k.  :' 
flesh,  or  of   vegetable  matter.      Sa^o  i<  often  added:    ami 
to  heat    in    the  oven  for  an    hour  before  beiti^  added    to   tii'         ;:•,  ;• 
all  the  more  digestible.      The  same  mav  he  said    of   :,.: 
The    stai'ch-transformation     into    soluble    dextrine    1 


I''*  MANTAL   OK   PIKTKTirs. 

about.  Of  course  where  cereals  have  been  cooked  by  steam — much 
bettor  thiiu  boiling  water — this  starcli-transl'orniat  ion  is  more  com- 
plete. Whether  the  soup  lie  white  or  brown,  cooked  farina  can  bo 
added  \vith  advantage  as  raising  its  food  value. 

Meat  juice  is  of  course  a  better  food  than  a  meat  infusion,  as 
it  contains  some  albuminous  matter.  Mr.  Mann- Valentine  lias 
identitied  his  name  with  such  meat  juice.  Others  have  followed 
in  his  footsteps.  Murdoch  has  mixed  meat  juice  with  the  juices 
of  vegetables;  a  capital  combination  —  in  theory.  But  such  prepar- 
ations arc  not  acceptable  to  the  genuine  Briton  with  his  insular  pre- 
judices. 

Then  there  are  m  the  market  "  lactated  foods."  That  is,  com- 
binations of  cereal  matters  with  milk,  desiccated.  These  arc  all 
trood.  And  variety  is  us  acceptable  to  persons  who  are  put  upon  a. 
''regulated  dietary"  as  for  other  more  fortunate  persons,  who  can 
eat  what  they  please. 

The  stinir  of  a  "  regulated  dietarv"  lies  in  us  monotony.  The 
palate  palls  at  the  restricted  variety  of  food,  and  the  person  abstains 
from  food  as  much  as  possible — hungers,  in  fact.  Austin  Flint  and 
Lander  Brunton  arc  ipnte  riirht  in  their  criticisms  on  the  elfects  of 
a  ''  restricted  dietarv."  Still,  the  dietarv  mav  lie  judicious  and  ap- 
propriate, and  vet  he  varied  •-/.'•..  if  cither  doctor  or  patient  know 
enough  u  poll  the  subject .  That  is  where  the  shoe  pinches  !  Xeit  her. 
comnioiilv,  are  suHieientlv  familial'  with  food  m  all  its  aspects,  to 
•ret  over  the  ditiicultv.  It  is  want,  of  knowledge  on  ciilinarv  mat- 
ters, that  makes  the  dietary  so  restricted.  And  as  our  acquaintance 
with  food  increases,  and  familiarity  with  cookerv  books  becomes 
part  of  medical  teaching,  the  ditliculty  will  be  e;ot  over:  and  the  in- 
valid and  dyspeptic  be  proportionated  trrateful. 

The  seieiitilic  aspect  of  food  must  lie  united  in  the  bonds  of  ho]\- 
matrimonv  with  a  practical  knowledge  of  the  cook's  art.  before  a 
man  can  discourse  learnedlv  of  food.  And  another  matter  is- 
nevcr  take  for  granted  that  any  cooked  coinpound  will  necessarilv 
l)c  nict — either  to  the  eye  or  palate.  Taste  and  try!  That  is  the 
onlv  solution.  I  have  been  a  judire  at  a  food  show,  and  ate  some  of 
all  the  exhibits:  the  palate  beiiiLr  mart  vred  to  a  irreat  extent.  1  have 
tried  most  babv-fooils.  I  have  hcid  deep  consultations  with  cooks 
and  housewives:  I  have  experimented  with  loods  to  ascertain  the 

food-value    in    relation    to    cost    for    some    articles,    ("I-' 1    for    the 

Economical")  in  linml  ll'o/v/>,-  I  have  eaten  everv  vai'ietv  of 
tinned  and  preserved  fruits:  in  faet.  mv  person.il  experience  extends 


over  the  whole  known  lieM — except  a  cod-liver  nil  emulsion.  'I'h.-it 
is  a  fiTi'ii  i /n-inj/i iln  to  inv  jjftistatorv  nerve  fibrils. 

Malt    Extracts.- -The-c    an-   <]iiite  a    modern    form   of    r i. 

HoiT's  first  idea  w;is  a  preparation  oi'  nuiit  whieh  should  contain  all 
the  qualities  of  beer,  without  the  inioxicat  mi:  alcohol.  Tin-  malt- 
ster malts  the  LTam,  l>v  which  a  certain  starch  transfonnation  is  pro- 
duced: then  the  brewer  mashes  the  malt  with  hut  water,  hv  which 
further  starch-transformation  is  effected :  and  hi-  "'  w>rt  "  is  a  ,-wect 
lluid.  rich  in  maltose.  The  brewer  then  adds  his  veast  t<>  tin-  \\ort 
and  then  the  maltose  (or  irrape-supir)  is  fermented  into  alcohol  and 
carbonic  acid.  The  malt  extract  manufacturer  stops  at  the  won; 
and  instead  of  addmi:  veast,  evaporates  the  wort  in  a  vacuum-pan, 
into  a  fluid  like  molasses.  A  malt-extract  is.  however,  something 
more  than  either  molasses,  honey,  or  invert  su<j;ar.  It  contain.-,  as 
well  as  carbo-hydrates,  some  soluble  albuminoids  and  salts.  In  fact, 
it  forms  a  verv  excellent  food.  It  is  not.  however,  as  complete  a 
food  as  milk,  as  it  lacks  fat.  Some  advertisements  of  malted  foods 
talk  of  their  lieinn-  "substitutes  for  milk."  That  they  are  not:— 
and  cannot  be!  J»ut,  a  malt-extract  is  a  lovely  food  all  the  same. 
And  when  a  stomach  is  in  active-  revolt,  a  teaspoon  fill  of  malt  -ext  ract 
every  hour  is  an  aliment  which  offends  it  neither  bv  bulk  nor 
qualit  ies. 

.Malt-extracts  have  been  lauded  for  their  diastasic  power— their 
capacity  to  digest  starch:  but  the  diastasic  power  of  a  mall-extract 
is  far  below  that  of  ordinary  mall.  (ipMind  malt  lias  a  u'l'cal  future 
before  it.  As  the  digestive  organs  are  enfeebled  bv  the  advance  uf 
civilization,  predi^ested  starch  mus!  come  more  and  rimiv  to  the 
front.  And  ground  malt  added  to  baked  flour,  or  baked  farina  in 
anv  form,  before  the  hot  milk  is  poured  on.  make-  a  nio-t  lilies;  .hie 
dish.  This  milk  pudding.'  should,  when  mixed,  be  placed  on  a  ii"t 
plate,  or  anywhciv  else  where  its  heat  will  be  main; allied,  and  then 
the  diastase  of  the  malt  acts  prom ;  it  1  v  upon  t  he  farina.  Such  a  m  .  !k 
pudding  is  verv  fluid.  It  requires  no  cane  -ULi'ar  to  sweeten  it. 
This  is  a  trreat  matter  with  stomachs  in  which  ordmarv  cane 
siiLrar  swiftly  turns  acid.  An  eu'.u'  mav  lie  added  or  not,  accor,  im;r 
to  circumstances.  Tin-  is  a  far  more  eilicienl  method  of  pre- 
diu'cst  HILT  stai'ch  than  IIHXIHL;'  a  malt-extract  witii  a  milk  pud'  ;:iLr 
before  servnii:'  in  the  nur-crv. 

<)n  the  other  hand,  a  mait  extract  i-aii  be  ma  ie  a  p  • 
a^'c  bv  diluting  it  with  a  little  water,  (to  make  it  of  the 
of  a  svrupl.  and  then  adding  an  ai'-i-alcd  water. 


i»  MANfAI.    ()K    IHK.TKTirs. 

Gruels. — The  admixture  of  farina  \vith  water  or  milk  forms  ;i 
i^rucl.  Oatmeal  is  tlic  form  of  farina  usuallv  employed  in  the  mak- 
ing of  ^ruel.  lloiled  in  water  with  a  knoli  <»f  suirar  dissolved,  and  a 
piece  of  butter  added,  oatmeal  LTUC]  is  reckoned  a  sovereign  remedy 
for  a  eoM.  Oatmeal  ^niel  made  wild  milk  is  splendid  food.  As  the 
porridge  of  Scotland,  and  the  North  of  Kn^land.  this  is  the  staple 
of  breakfast  with  the  whole  of  the  working  population:  which,  in 
thews  and  sinews  as  well  as  hones,  can  stand  comparison  with  any 
race  on  the  earth's  surface.  An  excellent  sustaining  drink  for  the 
hav  or  harvest  ticld.  for  foundries,  stoke-holes,  etc.,  is  supplied  l>y 
adding  a  handful  of  oatmeal  to  a  gallon  of  water. 

Boiled  arrowroot,  was  once  in  yo^ue  for  invalids,  l>ut  is  not 
fashionable  at  the  present  day.  It  wa-  vcrv  irood  fuel-food;  and 
sweetened  with  sitLfar  and  flavoured  with  wine  was  not  at  all  unpalata- 
ble. r>u t  it  is  inferior  in  every  way  to  a  "treacle  posset."  This 
last  consists  of  a  pint  of  milk,  a  tables) loonfnl  of  treacle,  a  teaspoon- 
ful  of  powdered  -invvr.  with  as  much  nun  as  the  drinker  fancies. 
Not  only  is  this  Lrood  for  a  cold,  but  it  has  a  lii^h  food-value.  Such 
a  posset  last  thiniron  ^ettini;  into  bed,  would  cheer  many  a  starve- 
ling, and  ill-nourished  person. 

Eggs. ---The  e".-;_;-  i>  certainly  a  fluid  food  until  its  albumen  is 
consolidated  by  heat.  AM  eirjx.  beaten  up  with  eoil'ee,  is  a  drink 
re];>hed  by  many.  Others  prefer  it  with  sherry.  Some  like  it  with 
milk  and  brandy.  With  a  pinch  of  pepper  and  salt,  and  a  little 
vinegar,  an  ev/ir  form-  "a  prairie  oyster."  The  white  of  an  e^ 
addeil  to  liome-made  lemonade,  enables  it  to  be  frothed  up.  This  is 
a  piea.sint  and  nutritive  drink.  I  nder  ot  her  circumstances  t  he  yolk 
i-  the  part  preferred.  It  can  lie  taken  with  wine,  or  milk  and 
brandv.  The  yolk  of  an  e^  is  a  constituent  factor  of  the  "rum 
and  milk."  so  famoii,-  in  the  treatment  of  phthisis.  Half  a  pint  of 
milk,  the  newer  and  fresher  the  better,  the  yolk  of  an  e<_rLr.  a  tea- 
spoonful  of  su^ar,  a  suspicion  of  nutmeg  and  a  spoonful  (thesixe 
varies)  of  rum.  all  beaten  together  and  taken  the  tirst  tiling  in  tin; 
morning,  has  been  credited  with  the  cure  of  many  cases  of  consump- 
tion. Taken  early,  it  will  often  prevent  the  exhausting  sweats 
which  accompany  tin-  mornniL:'  do/e.  I'm-  this  purpose  it  should  he 
taken  about  six  or  so,  and  after  it.  the  patient  often  sleeps  protected 
atrainst  hvdrosis.  <  >r  ;t  may  be  taken  Itcfore  dressing,  and  often 
enable-  an  invalid  to  Lr<jt  over  that  tiresome  process  without  a  sense 
of  exhaust  ion. 

Syrups.— Then  there  are  syrups  of  various  kinds.     The  ( Icrmans 


are  fond  of  strawbcrrv  svrup.  and  ra.-pl>errv  syrup,  to  drink  a- 
aLfes;    especiaiiv  to  breakfast,  in  hen  of   tea  or  roil'ei-.      The- 
arc  vei'v  palatable,  and  dce;dcdiv  nutriti\e. 

Svrups  of  all  kinds  arc  in  \  O<_MIC  at  present,  to  d  niik  \\  ,t  h  a>  !',;;•  d 
watej-s.      Thev  were  in  fashion  in  the  pas;,  with  ho;   water,  and  were 
drunk    for  a  cold.  <ir  when   coming  in  from  exposure   to   cuid.       l-'e\\ 
middle-ai^ed    persons  cannot    remember   the   eiderberrv  svrup   wluc 
was   made   in   every  household:    and   verv  nice   it    \vas     a:    lea-: 
person  t hiuks. 

There    are    manv    circumstances    where    fluid    f'»id    is    d''-;raMe. 
\\"hat  is  most    wantei'i  is  a  knowledge  of   how    to   u'ive    food-\ait;c   to 
meat-iiifusions;    and  on  this  section  of  the  subject  a  murderous  mis- 
Upprehension    prevail-   at    present,    which    may    well    be   dis-ipate. 
with  advantage  toad  .-!<•!<  persons. 

Koumiss.-  A    lluid    food   now   becoming  rather  fashionable.  ;• 
fermented    marc.-'    milk.       Kari\   travellers   in    Tartarv  sp->kc   ..;'   this 
fermented  mares"  m ;tk  as  an  intoxicat  inu"  di  ink  amon^  1  lie  Kalmucs. 
Its  intoxicating   projtert ies  are  small  as  n-pi P is  \\  e.-ti  rn  race-.      The 
casein   of   mares'  milk  forms   the   line,  iloeeiilent  cur,!    characteristic 
of   woman's    iin.k:    contrasting  \\ith    the   so,;d    ciii'd    of  cows'    mi  k. 
As   a   cure  for  phthisis,    it    ha-   a   di.-tinet    reputation    in    the   ea- 
Knrope.       I ))-.    Cai'rick.  of   St.    Petersburg,  bad    a    number  of   ma:v 
brought    to    Mi iLi'iaii1  i    and    exbibitcl  at   South    Kensington    in    1-^1. 

lie    had    studied,    the   matte]1    thoroughly,  and    written  a  small    i :\ 

on    "  Koumiss "( published    by    Iilaekwood    and    Son-).       He  showed 
Koumiss  made  from  mar"-'  m  i .  k  as  on  t  he  Steppes.       1 1   \\a-  a  pica-- 
ant  drink  with  the  curd  in  .-mail    lloeeuleni    ma-se-.      \',\\\ .  a-  he  , 
served  to  me    -"  I\oiim;-s  is  cumparat  ivelv  n-ele--  in  a  damp  <•  .m-v 
like  Mnu'kuid,  because  a  person  cannot  drink  en»ii;jdi  "f   ;:.      (  1-1  ' 
arid    Steppe-.    wlM-i'e    the    evaporation    of    ;!u!d    1-    ii'real,    a    <',<•  .--.i:-- 
per.-onean  wit  h  i-asi-  drink   from  lifteen  \>  <  -.:/.-":i  champagne  o'la  r;  - 
of    Koumiss   in    a   da\'.       1   nc,er    tho-i'    cireiim-iaiice-; 
Koumiss  are  often    very  striking. "      l-'rom  tl'ii-  ;;   would    -cei 
is  comparat  ivelv  useless  to  t  rv  Koiim:.--  cxcep:  nn  t  i;e  M  .•; .    .•-.      i 
fainlv  in  pvrexial  state-  :t  may  In-  found  a  plea-ani  ilr.'nk:   a1 
esneciallv   suited    lo    irritable   eonditioiis   o!'    the    -lomac'n.  :, 
interciirrenl  gastric  di.-i  urbance-;   of   phth:-:        ^vhci-e  tii.  :••• 
rise  of  temperature.      1  n  some  ca-e-  it  -  ^ i  eil'e  -;  -  a  :•>•  \ '< -r\  a  •  i 


CTTAPTET!    Till. 

I'KFSKKYFl)    AM)   CANNKD  FOODS. 

THE  qualities  and  properties  of  foods  arc  n»\  altered  by  the 
moans  resorted  to  for  their  preservation,  at  least  to  any  material 
extent,  as  regard s  their  food  value.  Still  preserved  foods  rei|iiire 
some  attention  in  a  \vork  of  this  kind. 

1'rohahlv  the  earliest  method  <>f  preseryini;  Food  \vasa  blending 
of  salting  and  drying.  N(|t  only  was  tin-  pi_r  so  converted  into  bacon 
and  ham.  luit  the  fattest  o\cn  were  selected  in  October  and  salted  — 
the  rest  lieinir  turned  loose  to  find  their  \vinier  food  as  best  they 
eoulil.  Mutton  hams,  too.  were  a  delicacy.  <  Mi  such  salted  pro- 
visions the  hulk  of  families  in  the  country  lived  durini:  the  winter 
month-.  The  piir.  which  could  be  fed  on  corn  and  the  slops  ol'  the. 
household,  supplied  the  sole  Fresh  meat.  IF  the  piir  \vas  no;  at  hand 
(and  in  Scotland  of  vore  the  pi  LI'  was  as  objectionable  as  an  eel)  and 
some  fresh  food  was  craved  after,  the  cattle  were  driven  into  a 
pound,  and  bled,  and  this  blood  was  mixed  with  harlev.  made  into 
a  pudding,  baked,  and  eaten.  \Vheii  the  pi-'  was  slaughtered,  the 
blood  was  made  into  a  "black-pudding"  winch  kept  well  for  some 
week-.  Sausages  were  made  of  the  fat  and  lean  meat  chopped  to- 
gether and  Havored  with  saLi'e  and  othei'  condiments.  Uacon  is  a 

f 1   of  tlii-  greatest   value:    the  lean  is  apl   to  lie  hard,  hut  the  fat  is 

of  the  most  excellent  character.  Il  is  easily  digestible  and  agree- 
able to  tiie  palate.  It  may  be  fried,  as  the  rasher:  and  rashers  of 
bacon  with  fried  or  poached  CLI'LTS  is  a  stock  breakfast  di-li  over  the 
length  and  breadth  of  F.iiLrlaiid:  or  it  mav  lie  boi  calen  cold 

with  pickles.  licyond  that,  too  i';it  liacon  is  used  to  lard  fowls,  nver, 
venison,  etc.,  to  add  to  drv  meat  as  ihe  hare  and  rabhil  (which 
should  always  he  ste\vei]  w,th  some  pieces  of  fat  bacon).  ;ind  to  \eal 
in  a  p:e.  However,  as  a  mailer  of  fact,  it  is  if  :  .  too  little, 

u-ed  as  an  adjunct  to  other  food.  The  inside  fat  of  the  pi^  is 
"  rendered  "  into  lard,  which  is  used  in  the  making  of  pa.-trv.  The 
hams  are  a  Favourite  tood,  and  a  slice  o!  eoM  hulled  ham  will  usuallv 
sit  ea-ilv  upon  the  mo--t  fa-!  d  <•'  -tomacli.  In  spi-akiuif  of 
Lfast  I'it ;-."  A:;-';n  I-  :  '.  aft'  r  recoinmi  ndiiiL:'  m;ik  ami 


PRKSKKVKI)    AM)    CANNKD    K<>n|)S.  T:', 

farinae.eo  s  food,  quotes  Jaerond  who  was  1:1  favour  "fa  die*  ,, 
mal  food.  "  He  advises  that  the  patient  he  encoura:_r('d  t"  tak"  *•<<••£- 
taiti  kinds  of  food  which  arc  supposed  t"  c\. •;;.•.  more  than  oih.-r 
kinds,  the  secretion  of  gastric  juice,  and  In-  mentions  boiled  !;aiu  as 
part icularly  eligible  for  that  purpose."  A  thin  -lice  of  tin1  Van  of 
hoiled  ham  cut  across  the  lihre.  well  mast  icat  ed ,  will  n<>  doiiiabe 
tolerated  hv  a  verv  irritahle  stomach. 

Sausages  are  a  verv  toot  h sonic  form  of  food.  As  ord  inaril  v  made 
they  an-  known  in  London  as  ".-kin  and  mvsterv:"  and  the  revela- 
tions which  come  out  at  times  about  sausage  inanufactorii's  are  cer- 
tainly startling.  Still  on  the  whole  they  arc  fairlv  trust  wori  hv.  and 
their  main  adulteration  is  the  bread  crumb  added.  Ordinarv 
Kntrlish  sausages  are  a  u'ood  mixeil  food. 

Then  there  are  foreign  sausages  as  I'.olo^na.  Strasburir.  <lotha, 
Leherwurst .  and  the  toothsome  (iui is  Leberwurst  made  of  the  Boose's 
liver.  Thev  arc  all  savoury  ui  a  1  manv  of  them  rieh  in  fat.  Thev  are 
suitable  for  persons  with  defective  teeth,  as  the  meat  has  all  been 
tineiv  divided  before  heini;'  passed  into  the  skin. 

All  sausages  which  contain  the  tlc-di  of  the  pi^.  as  will  as  baeon 
and  ham,  are  liable  to  contain  the  Trichina  Spiralis:  wh;ch  is  mdv 
destroyed  hv  proper  cooking.  Trichinosis  is  speciallv  found  where 
ham  is  eaten  hut  little  cooked,  if  cooked  at  all  in  some  cases. 

Potted  meats  arc  all  savoury,  from  bloater  paste  up  to  /, 
fun-  <ir<i*.  Thev  are  all  liable  to  such  manipulations  as  to  allow  "in- 
to say  of  thorn,  "am!  things  arc  not  what  thevseem."  /'</ 
<jri'.<  often  contains  but  a  suspicion  of  goose's  liver,  for  instatn'c.  All 
[lotted  foods,  whether  iish,  llcsh,  or  fowl,  haw  of  course  been  thor- 
oughly disintegrated,  and  as  such  are  suitalile  for  dvspeptics.  Tiiev 
do  not  usuallv  form  the  /ifi'n'  </*'  rt'sixtniif  of  a  meal,  but  are  savoury 
accessories.  Little  tinv  sandwiches  of  stale  lu'caii,  cut  th;n  and  the 
butter  well  I'libbed  in.  and  then  some  potted  meat  added,  will  often 
tempt  a  dainty  appetite.  Potted  meats  are  u-itallv  highly  -ailed; 
a  mock  jn'i/i'  ill',  /'oil'  ill-it*  made  with  larded  calves'  liver  seasoned  is 
a  very  nice  food.  All  these  potted  foods  are  '"  reli.-hcs,  "  rather  than 
n  latenal  art  icles  of  d  let. 

Pickled  foods  arc   preserved    by  vinegar  or   hrinc.      All    kind 
of   Iish  arc  pickled    in    brine,  especially  herrings.      They  i'eot;:!'e  1 
soaking  in  \vatcr   before   the  salt   can  be  -•";    out    of   them.       P.ck'.i  d 
l>ork  is  a  ii'i'cat  food  with  luiiiher-nien  and  ot  liers  who  have  to  !av  :n 
stores   of    provisions.       In    the    I".  S.   A.  a    winter    with 
with  plenty  of   fresh   air.  exercise,  and  the    fat    pickled   i--k.  | 


(4  MA  NT  Ah   OK    IMKTKTK'S. 

to  be  a  jrrand  preventive  measure  in  threatened  phthisis.  Mussels; 
and  ovstcrs  are  pickled  in  vinegar  and  are  vcrv  jiiras;int  forms  of 
food.  Hried  ami  smoked  meats  an-  vcrv  palatable  forms  of  food. 
Fish  ivudilv  lend  themselves  to  tins  process:  kippered  salmon  are 
famous,  and  so  are  "kippers"  a  form  of  split  lierriiiLr  dried. 
''  /•'///'/"//  haddies"  are  \vcll  known,  and  eijuallv  so  is  the  Yarmouth 
bloater.  The  dried  liaddoek  is  unobjectionable;  Imt  the  other  forms 
are  apt  to  upset  the  stoiuaeh.  and  can  onlv  lie  sat'clv  indulged  in  by 
persons  -who  can  trust  their  digestive  powers.  Kippered  salmon 
broken  up  small  (after  cooking)  and  mixed  with  mashed  potatoes, 
makes  a  capital  lish  pudding. 

Pried  lish  of  a  common  oi'dcr  were  one,'  the  animal  food  of 
Kuropc  in  Lent.  They  require  iiiucli  soaking  aiid  have  a  low  food 
value. 

Anchovies  are  hoth  dried  and  pickled  as  well  as  potted.  AH 
anehovv  011  a  beefsteak  imparts  a  pleasant  flavour  to  it.  Anchovies 
arc  usuallv  related  to  hot  buttered  toast,  and  hence  arc  not  desirable 
for  the  d  vs  peptic.  ( 'a  via  re.  the  roe  of  the  si  uruvoii.  is  not  acceptable 
to  all  palates,  but  it  has  a  hi^h  food  value  of  albuminous  character. 

Tongues  are  often  dried,  and  when  soaked  and  boiled  arc  -I'od 
and  palatable  food.  Cut  thin  across  thevrain.  toiiiruc  is  like  ham 
as  regards  its  tolerance  bv  the  stomach.  The  h'us.-ian  tongues  pos- 
se-- unite  a  iramc  flavour. 

Vegetables.  Sometimes  vegetables  arc  preserved  bv  drviiiLT.  as 
seen  in  the  vegetable  matter  prepared  for  .lulieniie  Soup.  Thcvare 
sometimes  also  compressed  as  stores  for  tlcets  and  armie-.  Thcv 
reijinre  soaking  and  then  probabiv  ditTcr  little  from  their  kind  in  a 
fre-h  state.  Manv  veirctablc  matters  arc  p:i-kled  as  relishes  to  food  : 
notably  the  cabbage,  the  small  onion,  eschalots,  •jfherkius,  cauli- 
flo\ver,  etc.,  all  of  which  are  trviuir  to  the  digestive  or"jans.  \"e^c- 
tables  lend  themselves  readilv  to  the  tinning  or  canning  process. 
Asparagus  so  treated  has  Ion LT  been  held  in  repute.  The  /«•///.*  jmix 
of  !•' ra  lice  are  in  i  ilia  t  ure  peas,  not  to  be  com  pared  for  a  moment  with 
the  lai'Li'e  marrowfat  pea-  of  American  production.  These  last  onlv 
reijiiire  the  addition  of  a  little  sui/ar  when  heating,  to  cnaldc  them 
toeumpete  on  fa i i'l v  ei j ual  terms  with  frc-h  pea-.  Lima  beans  are 
also  tinned  and,  keep  well.  Succotash  i-  a  compound  of  the  hiirhlv 
nit  roiT''iiiscd  legume  witli  mai/.e  and,  rieh  in  fat.  Mai/.c  in  tins  as 
"  SiiL'ar  ( 'orn  *'  is  a  beautiful  ilitfc.-!  ble  dish,  whether  eaten  with 
suirar  and  milk,  or  with  butter,  pepper  and  salt.  The  baked  beans 
of  New  Knir'iaiid  hold  a  hiirh  o-ition  as  a  food,  no  matter  from 


I'RKSKKVKD    AM>    CANNKD    KOMI.-,. 

what  point    of   view  they  are   looked  at.      Kach    tin   ,.,,    ;  ., 

ol    fat    bacon    bi^er    than    an    t'L/Lr.      'I'll'1    bean-   an-   so   • 
cooked  aiii!  the    fat   intermingled  \vith  tin-  material   of    tin1  :•••.:: 
the  hiu'h  tempi-rat  u iv  at  which  tin-van-  liaki-i  ( wliii-h  1- 
its    etl'ect    upon    the    stan-h).    that    they    n-;nliiv   di-inte-rat 
month:    while   the  fat  is  in  a  form  wliich    Drives    iittie  oil'i-n.-e 
stomach,      l-'or  food  value,  for  cost,  tln-v  stand  \vrv  hi-'ii.       I-'1,  i-;  :..•;•. 
they  will   come  into  votrue  ere  lonj;  with  persons  who-e  .-toinac;;-  are 
fast  iilious  aliout  fat. 

Vegetables  are  easilv  stored,  and  a  NO  are  easilv  p;v-er\  ,•.':  ',..  :  :.-. 
us  potatoes,  carrot.-,  turnips,  beet,  etc. 

All    .vv//.v   c;1li    |,c    preserved     lll'V,    as     those     of     the     cclVuN     ;il;d      tile 

legumes,  and  as  such  form  a  iarjj'  portion  ()f  til''  fond  of  man. 

Fruits  arc  variously  preserved.  As  prepared  wi-h  su^ar  l»v 
lioduiu'  thev  have  lieen  spoken  of  before.  The\  are  a,-o  bot;.cti, 
and  were  at  one  time  at  least,  lar^clv  adulterated  u,;h  i-oppe]-  to 
secure  a  ur"()d  LTi'een  I'oloui'.  ( )nee  a  ['!'u<ieiit  man  a!  u  a\  -  |nit  hi.-  i  »•!;- 
knife  into  irret'ii  pickles  and  fruit.-,  to  .-er  \vlia'  amount  ,>:  •,.;, pel- 
was  ilepositt-tl  on  the  .-tccl.  Olives  ai'e  la:'-jv,\  In.; ;;,»».  ; 
usuaiiV  eaten  IM  clear  the  palate  before  drinking  ;';'.••  \\  .:.••-.  'I'hev 
are  I'ldi  ;n  oil.  lied  fruits  art-  apt  to  be  stained  hv  \"^\\  <  <<»\.  Mi- 
beetroot  juice  to  impi-ove  their  colour. 

Tinned  or  Canned   Foods.     Tinned    fruits  are   i,,. 
favour.      Tin-  apple,  tin-    pe;ir.  the  plum,  the  ^rape.  the  •:;;:!:••••.  ; 
cherrr.  the  jieach.  and  u[irieot.  all   tin  eapilaiiy.      T 
julilitiotis  to  the   diniiei1   tali'.e    in    winter  and    spr:n^.  •    ' 
ai'e  or  cooked.      Tinned   cranberries  are    far   super,":1 
astringent  native,  cranberries  ol  (in-at   [SiMani. 

Apple  rin^s  are  also  ^amniL;'  favour  with  the  !io;i-e\\   ;'e. 

It   ma\-  be  said  as  a  rule  that    vegetable    proiiu.-t-.  tin  o;-  can  moj-e 
stieeessfuliv  t  lian  li-li  and   flesh. 

Tinned  salmon,  t  hoiiLrh  of  -'ocd  fond  value,  l.-^-k-  :  h- 
fiv-h    salmon.      Tinii'-d,    lobsters   vary    very    much,   n 
to  the  length   of   time  the  ti-h  has    been    in    tiie  can.       A 
lobster    i-    nut    to  be  despised      -when   a    fl'e-1     I,.:,--, 
And    tinned    salmon    will    pot.  or  make   a    -.i,,,;    ;  -• 
with  ma-heil    [lotatoes.      (tther  li.-h.  a-  '     !'bn'.  cmi.   n  ,. 
fi.-h.   piiehanls.  and  herriiiL;.-  tin.  aii'i  Him  out   ta  r 

The  sanliiu-    preserved   in  oil  i-  well   known    t«|   m 
j^ood  tish  food,  and  mixed  with  it.-  oil.  \\      :  a  nrop 
ter  sauce,  is  ilecidedlv  aurreeable  to  the  palate. 


7»'>  MANUAL   OK    DIKTKTICS. 

small  fish  get  mixed  with  the  sardines,  but  tliis  scarcely  constitutes 
adulteration. 

There  is  one  tinned  fish,  however,  whose  flavour  is  little  affected 
by  the  tinning  process,  and  that  is  the  shrimp  or  prawn.  The 
Barataria  shrimp  is  delicious  out  of  the  tins. 

Why  the  crab  is  not  tinned  —  not  the  small  soft-shelled  crah 
which  does  tin — Imt  the  ordinary  crab,  is  unknown  to  me.  1'roha- 
lily  there  is  some  technical  dillicultv;  also  tlie  eel,  which  would 
seem  a  jinm'1  to  he  wdl  adapted  for  tinning.* 

In  (Icrmany  eels  are  pickled  and  sold  in  small  barrels. 

Tinned  meats  have  established  themselves  over  t  he  face  of  the 
earth.  Of  course  these  tins  of  various  si/es  are  most  convenient  for 
stores.  A  small  quantity  can  be  used  at  once — a  great  matter. 
Whether  beef,  mutton,  or  pork,  as  a  rule,  it  mav  fairly  be  said  the 
meat  is  overdone  and  stringy.  Minced  meat  is  fairly  £Ood  and  nice, 
and  mixes  well  with  mashed  potatoes.  Tinned  tongues  are  really 
very  good  indeed:  the  llesh  of  the  tongue  seeming  to  lend  itself  to 
the  preserving  process  very  readily.  Little  .-beep's,  tongues  are  de- 
cided delicacies,  and  so  are  t  inned  sheep's  tails.  The  hare  and  rabbit 
tin  moderately  well.  Turkey,  goose,  duck,  fowl,  and  ^amc.  come 
out  not  amiss.  Drawn  is  fair,  and  boar's  head  deeidedlv  good. 
I'ig's  feet  in  tins  eat  capitallv. 

Venison  1  have  not  had  a  sutlicieiit  experience  of,  i,c.,  in  tins, 
to  vent  lire  on  an  opmi<  >n. 

A  . />'.  One  mat ler  about  tinned  meats  is  never  to  be  forgotten, 
vi/.  :  t  he  i -MI  it  cuts  of  a  tin  ,-hoii  Id  be  consumed  as  <m  n-k  1  v  as  no-si- 

•  .  1 

ble  after  IM-IIIL:  opened.  \o  food  improves  bv  keeping  after  being 
cooked,  and  this  is  speeiallv  true  of  tinned  meat-.  The\-  not  only 
beeoine  mi  palatable  but  even  positively  unwholesome:  bv  usin^-  them 
up  at  once  the  most  is  made  of  them. 

Milk  is  now  iargeiv  preserved  in  tins,  hoi  h  Swiss  and  other  milk. 
That  sueli  tmiieil  milk  is  a  great  boon  for  town  populations,  and 

SpeeialiV    for    vollllg    children,    there    call    be   no   doubt.         K\e||     ill     the 

eountrv  where  milk  i-  not  alwavs  as  easily  procured  as  some  mav 
think,  the  tin  of  miik  comes  in  very  liandv. 

Cream  is  more  difficult  to  manage.  I'artially  de.-iecati'd -—-as 
I  )evon-lnre  ( 'ream,  it  is  well-known  all  over  Kngland.  ('ream  is  a 


PKKSKKVKI)    AND    CANNKD    FOODS.  77 

highly    nutritive    bndy,    verv  rich  in    fat    in    an    eiinii-innir-ed    fiVjn. 
Sonic  tune  a<:o  1  wrote  to  the  .\V//-    }"<//•/'•  //<•/•"/'/  siiLrLr<'st  ini:  the 
niiii;'  of  cream.      An   enterprising    man  in   !<>\va  sent    me  ma:.v  - 
pics;  sonic  tins  turning  out  well,  hut  inanv  until   fur  fond.       I>u:  ;h«- 
tiling  could  never  lie  relied  upon,  and  so  was  cnmnicrciallv  a  fai.urc. 
A  Dutch  linn  seems  to    have   been    more  successful  liv  an  K.xhiblt  in 
t lie  Inventories  ( 1  xx'i). 

The  products  .of  milk,  however.  ;is  butler  and  cheese,  keen  ad- 
mirably. When  luiticr  has  to  lie  kept,  some  salt  is  added,  and  how 
lon^  salted  butter  will  keep  is  unknown.  It  is  a  most  digestible  fat: 
though  of  course,  the  object  of  churnim:  is  to  uvt  the  fat  out  of  ;M 
eniul.sioniscd  form.  It  is  larir('lv  used  eaten  to  bread,  and  is  invalu- 
able to  the  cook  for  her  dishes  and  her  pastrv.  Melted  butter  is 
eaten  to  li.-h.  and  adds  highly  to  its  nutritive  value.  Mutter  i<  de:ir 
comparat ivelv;  but  it  is  an  item  of  household  expense  that  should 
never  lie  Lrnidi,rcd. 

It  is  a  trrcat  mistake  to  cut  "'  nnrscrv  "  bread-and-bntter  thiek; 
if  the  butter  be  sparinirlv  applied  there  is  not  enough  of  it  ;  if  spread 

l~.il  1 

thick  it  revolts  the  stomach  with  delicate  children  of  feeble  dip'-ti\c 
capacitv.  The  bread  should  be  cut  thin  and  the  butter  nibbed  well 
in.  and  then  anv  child  can  cat  it  ivadiiv  —  vcs,  and  dip-st  i;  ton! 
Bread-and-butter  puddings  arc  capital  fond. 

Cheese  is  a  form  of  food  requiring  some  consideration.  It  ha- 
the  reputation  of  bein^r  most  iiulip-stiblc: 


This  applies  to  the  hiirhlv  flavoured  cheese  eaten  as  the  last  course  at 
dinner.      A  nip  of  ripe  (iorifonxola.  or  I'ochefort,  or  ('amembcrt.  or 
N'eufchatcl.  or  even  Stilton,  ('heddar,  Cliesliire,  or  double  (llouce-- 
ter,  after  dinner  j)rovides  a  fatty  a<-id  which  aids   the  cmulsion;-:n-- 
of  fat  in  the  alimentary  canal.      P>u;  this   is  scarcely  the  consider; 
t  ion  of  cheese  as  a  food.    ( 'heese  is  largely  eaten  as  a  blending  of  : 
and  relish,  bv  persons  with   whom  cconomv  is  a  matter  of  mo:i.i-!i:. 
It   is  either  eaten   as    it    is.  or  cooked.       A:    one   time   every    I'anne:- 
made  his  o\vn  cheese,  for  home   consumption  at  least.       \"\v  clicr-i 
factories  make,  as  a  rule,  so  much   heller   cheese  at  a  moderaie  pr  • 
that  chcesc-makiiiLr  i-  no  longer  p'lieral  with  farmer-'. 

A  ski  in  milk  cheese  was  a  t<>tii:h  all'air.  but  a  hi^hl y  conccir  i 
form    of  albuminous    fund.       A  cheese    made   nf   fiv-h  milk,  cni;1: 
a    lar^e    proportion    of    fat,    while    "cream-cheese"    coiit; 
casein. 


,s  MANUAL    OF    IMKTKTK'S. 

('asoin  softens  under  heat,  and  toasted  cheese,  or  Wi'lsli  rarebit 
are  sapid  and  savourv  morsels,  soon  falling  awav  if  kept  hot:  indeed 
it  is  \vell  to  wait  a  little  for  them  rather  than  to  keep  them  waiting. 
They  are  reputed  to  he  indigestible,  and  certainly  are  so  with  some 
person-.  Other  stomachs,  again,  tolerate  cheese;  and  there  are  horn 
"cheese-eaters"  as  well  as  ' '  cheese-haters. "  to  t  he  one  cheese  is  a 
poison,  to  the  other  it  is  most  acccptahle.  To  the  latter  even  when 
dyspeptics,  cheese  need  not  he  forhiddcn.  A  great  matter  is  its  dis- 
integration. Kinelv  grated  in  soup  or  even  hoded  macaroni  it  is  un- 
objectionable. Macaronic  cheese  done  in  the  oven,  or  lie  fore  the  tire 
requires  stronger  digestive  powers.  If  hominv  he  well  hoiled,  and 
then  grated  cheese  with  milk  mixed  with  it.  and  the  whole  put  into 
the  oven  to  brown,  a  delicious  digestihle  dish  is  the  result.  Crushed 
cereals,  shredded  mai/.e.  samp  and  broken  hiscuit  so  treated  with 
milk  and  cheese,  are  admirahle  food  sol'  high  food  value,  savoury,  and 
tinallv.  digestihle. 

Cold  cauliflower  and  vegetable  marrow  served  up  with  cheese  <iu 
iiratiti  are  very  good;  wliile  StalTordshire  folk  frv  cheese  with  bacon, 
and  for  this  end  prefer  a  crumby  cheese — not  otherwise  in  favour  for 
culinary  ends. 


CTIAPTIvR   IX. 

IMJKI'AIIKD    K<>nl>s. 

]\\  '' prepared  foods"  here  is  infant  the  foods  which  art-  sold  f.>r 
babies  and  invalids.  To  Lii-lii^,  ainoiit;  :<*  min-li  nioiv  re|aiin-_;  to 
food,  we  owe  t  he  i  lit  nxl  action  of  I'm  nU  specially  prepared  for  infa  nt  s 
The  food  uf  tlic  newl y-boni  is  milk:  but  many  attempts  ha\<-  lieeti 

made  to  substit ute  for  it,  mainly  "i1  in  part,  other  I' Is;   the   motive 

beini:  in  some  cases  cconomv.  in  iithiT  rases  the  ditliciilt y  ><l   |ir<n'nr- 
inu'  milk   in  siitTidcnt    ([iiaiit  it  it's.      Smuct  lines   the  niotin-r  muld  noL 

Sllrklr    tllf  child,    InMllU'   ill,   Hlld    Si  il  1 1ft  1  lilt 'S  licad. 

15  y  what  instinct  |irrs«ms  xvere  led  to  i-hoctsc  the  ci-ust  and  -ule  ,  ,f 
the  1<  iaf  to  Itoil  for  l>al  ties'  t'nod.  i -an  nmv  only  lie  a  inai  ler  oi'  speenla- 
tioti.  Ai'tef  t  IIO|-OUL;-II  liodinn'  i  he  water  was  |ioui-ed  «\\  nii>i'e  or  ies.- 
eoniplctely,  and  some  milk  added.  The  outside  of  the  loaf  i-  the 
part  most  thoroughly  exposed  to  the  baking  process,  and  [herel'ore 
in  it  the  standi  is  most  colliplelt'ly  cuiiyerted  into  ,-oluliie  dextrine. 
SiH'h  cai'bo-hydrate  matter  with  some  tVesh  cow's  milk  formed  ;i 
yei'y  complete  food.  lit  it  such  "  pobhs.  "  \vit  h  oni  y  a  1  it  t  ie  .-ti^ar  in, 
is  a  poor  food:  ;ind  the  marvel  is  that  such  lusty  infants  eyer  were 
raiseil  on  "  pobbs  "  as  undoubtedly  liaye  been  the  ease  in  I  he  ai;'r;eiil- 
tui'al  districts  of  Kn^land  and  elsewheri',  where  miik  is  not  ea.-ily 
[iroeiireil.  How,  and  by  what  means  ine  ^I'owinu'  oi'L:'aii!>m  has 
secured  materials  for  tissue-growth  out  of  this  improiiii.-iiiLr  food,  i- 
a  mysiei-y,  when  looked  at  from  a  seient itic  jio.nt  of  y'u-w.  Then 
came  rusks  ami  "  tops  and  bottoms."  all  howeyer.  maile  unh  tine 
Hour,  and  lackinu'  the  .-aits  and  albuminoids  of  the  lu'an.  Then 
came  the  introduction  of  malted  [)reparations. 

Something   has   been  said  before  about    the  preparation    of    ma 
extracts,  and  this  need  not  lie  repeated  here.     The  \\-on  is  e\  aporaie 
down    to   the  consistency  of   honey,  and  is  a  sticky  and    iron-.! 

f 1    to    handle;    albeit    a    lieatit  i  fill    food.       Asa  mere  food,   v, 

any   dia.-tasic   activity,    a    iii'\    preparation    like    Meiiin"- 
way  preferable.      There  are  do/en-  of  siicii  foods    n  the  n,a:-:\ 
yery  ^ood   foods   they  are,  too.      They  arc  <  specially    .•  - 


Si)  MAM'AL    OF    DIKTKTICS. 

to  milk  for  adults  as  invalids  and  dyspeptics,  and  to  a  little  milk 
and  water  for  babies. 

( 'omliinat  ions  of  liaked  flour  and  malt  are  no\v  sold  by  the  hun- 
dred as  tallies'  and  invalids'  foods.  They  varv  somewhat  in  com- 
posiiion.  Some  contain  more  malt  than  others:  some  contain  some 
desiccated  milk.  No  doubt  these  last  are  the  most  complete  foods, 
as  from  the  milk  a  certain  amount  of  fat  is  present.  They  are  also 
most  palatable. 

I'll  iv  malt  in  fine  powder  must  soon  he  a  regular  art  iele  in  the 
market.  It  is  economical  as  compared  to  t  lie  malt-extracts,  fluid  or 
dried,  and  contains  much  more  diastasic  activity.  Added  to  liaked 
flour  in  quantities  vurvinji  from  one-third  malt  flour  to  two-thirds 
of  !>aked  flour,  up  to  half  and  half,  and  then  hot  milk  either  poured 
on  — (for  a  pudding)  or  added  for  a  drinkable  food,  malt  can  he  made 
most  useful.  (! round  malt.  too.  contains  the  husk  of  harlev  and  is 
rich  in  phosphates.  Maltose,  dextrine,  soiuhle  albuminoids,  and 
phosphates,  all  are  there  in  a  very  palatable  form.  Only  fat  is  lack- 
ing. And  that  can  he  <rot  too.  in  theuvmor  hordeatus,  and  in 
oleohyne:  hoth  of  which  contain  milk-fat  in  eonsiderahle  proportions. 

The  ordinary  prepared  foods  in  powder  are  legion.  There  is 
one  in  MM!  t him;  about  this,  and  that  is.  there  is  choice  and  variety. 
One  form  is  unpalatable  to  a  l>al>v  or  invalid,  while  another  pleases 
the  palate.  The  palate  Arrows  tired  of  one  food,  then  trv  another 
fora  change.  .Monotony  is  the  curse  of  all  dieting,  and  should  he 
avoided  as  far  as  possible. 

A  medical  man  should  not  be  wedded  to  one  food,  but  should  IK; 
more  Catholic-minded.  This  is  a  matter  far  too  little  considered, 
and  yet  it  lies  across  the  very  threshold  of  resort  to  prepared  foods. 
C'liaiiLTe  about  from  one  to  another  just  as  you  expect  your  cook  to 
cater  for  yourself. 

Say  for  breakfast  the  invalid  has  some  milk  and  Mellin's  food; 
at  eleven  oV]oek  some  whole  beef  tea  with  baked  flour  in  it;  at, 
luncheon  a  milk  pudding,  made  with  broken  captain's  biscuit,  or 
other  biscuit:  at  tea-time  some  chicken  broth  witlt  .-Invddcd  mai/.e; 
and  at  -upper  a  digestive  biscuit  and  butter  with  a  Lrlass  of  sherry. 
IJv  attention  to  these  items — but  verv  important  items-  -the  invalid's 
dietary  could  lie  made  acceptable  instead  of  revoltinir.  as  it  too 
often  is. 

When  I  read  of  I  >r.  I  >avid  Vandal!  fasting  when  ill  with  typhoid 
fever.  I  knew  -Mrs.  Vandall's  capacities  as  a  housewife  too  well  to 
suppose  for  onu  iiioiiieliL  that  monotony  in  food  was  the  cause  of  Ins 


fast  MILT:  and  th;it  his  conduct  would  cause  dire  d<im<  -;'-•  ^\- '.  •'.  | ;  ••• 
IIUIMV  an  invalid  hungers,  partiallv  a!  iea-t  becau-e  he  ii»' 
vanetv.  \  ariciv  indeed  isopnte  as  acceptable  to  the  in\aild  ;.:.•';  :i.. 
d vspept ic  as  to  anvonc  else;  and  halne-  IK,  doubt  ha\e  tii'-.r  '•!:" .•••• 
about  food  just  as  much  as  their  cider.-.  l>e>-ause  tiic  poor 
t  li  in::  cannot  tell  us  what  it  thinks,  it  is  nut  therefore  iin-r-si;  \  '.<> 
assume  tliat  it  has  not  its  thoughts,  and  these  it  communicate-:  bv 
its  rejection  of  one  food  and  its  delight  in  aiioihcr.  A  \erv  VOUIIL;' 
habv  can  reason.  I  ri'ineinher  once  seeing  a  voiulit'iil  mother  uurs- 
in<r  her  lirst  hab\ .  and  put  t  MIL;'  t  lie  tnout  h  pieee  of  her  feed  m^-  iidt!  ;•• 
in  the  haliv's  mouth  and  \vonderiiiL:  whv  ;;  \\ouid  not  suck.  The 
bahv  u'ot  nothing  hut  air  when  it  dni  suck,  and  so  ahandoiied  the 
ctTort ;  it  did  not,  want  air;  it  wanted  milk  !  On  directing  her  how 
to  have  the  teat  lilled  with  milk  In-fore  [uittinir  it  in  the  hahv'- 
Jiiouth.  it  suckeil  awav  famouslv.  and  developed  into  a  lu-tv  cli..-, 
promisiiiLT  to  Li'row  up  into  an  ustutc  ^'orkshircmaii.  So  wiiii  ;iie 
jireparcd  foods,  one  Itahv  likes  a  ^omi  share  of  malt  in  the  "  food." 
while  another  prefers  a  certain  food  in  whi'-h  there  is  little  or  no 
malt:  while  another  a^ain  delights  in  a  food  in  which  there  i>  a 
certain  admixture  of  leguminous  ilour.  Tastes  thev  have,  of  cour.-e, 
and  preferences  like  other  and  older  folks  ! 

And  of  course  the  same  individuality  of  taste  and  palate  belong- 
to  d vspept ics  and  invalids.  llccanse  one  form  of  prepared  fnod  . 
distasteful,  it,  does  not  follow  that  all  are.  If  there  existed  a  little 
more  Mti vent  ivciiess  in  nurses  there  would  IKH  he  so  much  complain: 
of  moiiotonv  of  food  on  the  part  of  sick  persons.  \\lu-n  the  ///•  , 
consols  solelvof  milk  and  sclt/er  water,  heel'  tea  and  calves'  foo; 
jellv.  is  it  any  wonder  thai  the  palate  is  palled  ?  And  vet  this  is  the 
complete  raiiLiv  of  invalid  cookery  in  manv  households.  .\,>;  id!.-- 
a^'o  1  was  in  companv  with  three  Lfeiieral  prad  it  loners  two.  fair 
•^ooil  aN'erau'e  specimens  and  one  decidedlv  far  ahove  l  he  ax'erai;'1'. 
and  they  could  ^o  no  further.  It  was  txilv  t«K>  clear  that  thev  \\i-re 
not  in  a  position  to  all'ord  much  surest  ion  as  to  the  dietaries  <•'' 
their  pat  lent  s.  Thev  ail  an, -we  red  "slops  "  to  m  v  lead  MIL:'  '|i  <<•-;!<•:;; 
Inn  t  heir  acquaintance  wit !  i  "slops  "  in  concrete  form-  was  i;m  ;•  ed. 
Ni"et  there  was  no  reason  to  suppose  them  -pec, ally  i;_rn«rant  U  \  : 
t  heir  fellows, 

I'lvcrv  medical    man  oiiLfht    to   trv  the   \anous    prepared    foot] 
varioii-    wavs,    so    as    to    pei--oiiall\     unilcr.-taiid    nha*    he 
about     when    .-peaking    of    various    fom';-.       (Mhevu  -e    he         v;' 

dou;"   on    the    subject.      1    \\i-h    mv   acijuaintai.ce    u.:i.    ;.. 


>'_'  }IAM'AI.    OF    IMKTKTK  S. 

prepared  |Y><  ><ls  of  tin-  I'nited  Stales  was  ativt  hiiiLT  like  as  extensive 
as  ii iv  knowledge  of  tin-  prepared  foods  of  (livat  Britain,  for  then  I 
could  speak  fivclv  on  the  diU'erent  form-.  'I'o  ineiitioii  those  I 
happen  to  know,  \vould  exclude  iiianv  of  \vliieh  I  have  never  heard, 
which  inav  lie  etpiailv  ifood. 

All  sweet  foods  containing  malt  :_r<>  best  with  milk:  while  plain 
baked  (lour  suits  be-t  meat-infusions.  l,ent;i  preparations  have  a 
strong  llavor  whatever  mixed  with.  Tea  llmir  is  best  with  meat- 
infusion  a-  tlie  "  brose-ineal  "  of  Scotland.  The  hiv;h!v  nit  ro^enised 
character  of  all  leguminous  Hours  renders  them  suitable  rather  for 
the  halo  than  the  sick.  And  much  the  same  mav  be  said  about 
oatmeal,  as  it  does  not  airree  as  a  rule  with  a  sick  stomach.  Its 
richness  in  fat  has  something  to  do  w;tli  this,  ;ind  a  fattv  aenl  is  a])t 
to  be  breweil  therefrom  in  many  stomach-.  It  is  the  fat  in  oats  and 
maize  which  makes  them  objectionable  with  manv.  live  is  a  pleasant 
addition  to  wheaten  llonr  to  the  fancy  of  nianv.  as  seen  in  the  pum- 
pernickel of  ( iermanv,  and  tin-  brown  loaf  of  the  North  of  Knv;land, 
especially  in  the  farmhouses,  where  brown  bread  and  skim  milk 
cheese  are  lai'LTe  factors  in  the  dietarv. 

Prepared  foods,  which  contain  a  certain  proportion  of  desiccated 
milk,  have  a  hiifh  food  value,  and  require  only  water  (witli  a  pinch 
of  salt)  for  their  culinary  treatment. 

There  is  one  form  of  prepared  food  which  is,  so  far.  uniipie.  and 
that  is  the  eremor  hordcatus  of  Loeniund,  which  is  made  from  the 
best  cream  from  selected  herds  on  the  r,avari;;n  Aips.  depn\fed  of  a. 
certain  amount  of  water  and  prcser\  ed  by  malt  extract.  This  highly 
palatable  food  is  excellent  in  its  food  properties.  Ii  contains  somo 
album  moii  Is.  :i  considerable  quant  it  v  of  fat .  and  some  ear  bo- hvil  rates. 
It  can  lie  eaten  alone,  and  in  certain  cases  where  the  stomach  is 
irritable  and  contracted,  so  that  oniv  .-mail  quantities  of  food  can  be 
tolerated,  a  piece  the  si/e  of  a  ha/el  ni;t  mav  be  taken  everv  hour. 
For  an  invalid  in  lied  this  is  quite  Mitlicieni  to  keep  up  the  strength 
until  the  .-lomach  is  well  eiioirj'h  to  hold  a  larger  bulk  a!  once.  ( )r 
it  can  be  used  to  coll'ee  or  tea.  and,  i-  especially  indicated  in  those 
rases  where  cane  sii'_far  irives  nsi-  to  aciditv. 

( )f  like  character  in  t  he  mam,  i-  t  he  ni-u-  food  called  "  oleobvne," 
which  as  its  nan  e  nd  eates  is  a  conipmiii'i  of  fat  and  malt.  It  also 
is  verv  palatable,  with  a  hiv/h  food  \aiiie.  I;-  fat  !-  in  an  emul- 
-ioiiised  form,  and  therefore  very  ili-je<t  il'li-.  x::  -ii  food-  are  adapted 
to  per-ons  who.-e  1 1  s  -  ii  e  -  require  more  fat  and  vet  \\lio  dislike  cod 
liver  oil. --;i  very  larirc  coiiimiinity.  l-'or  persons  of  phthisical  ten- 


deney  these  f'onds  are  snitaMe.  while  tliev  keep  \ve!l.       !'••!• 
to  lie  thrown   much    i!|K>!i  ;i    meat   dietarv.   as  mi    huntiliL:   c\p,-., 
should     lliake     the-e     foods     part     "!'     their     -It  ire-.        'I'll'-',     a.-' 
dicated   for  persons  with    incipient     llri'j  lit  '.-  di-t-a-e.  a-   :,ot    i>.  -.; 
hi".'hiv  charged  \vitli  nitrogen.      Another  admixture   of   oii  and  ma; 
is  "  kepler,"  \vhere  the  oil  is  incorporated   with  ina',1   extra'-;. 

Then  there  are  coil  liver  <>;!  eiiiiil.-ions  ;,,  !,,•  con.-idei-ed.  Tin--.-. 
of  eourse.  contain  onlv  fat.  and  that  IP.  tin-  form  of  olcine  :!,.•  n... 
digest  il>]e.  luit  otherwise.  j  m>l  >a  1  d  v.  tin-  lea-t  valuaMe  form  of  fa;. 
(1  .....  1  coil  liver  is  fro/en  to  p.(  nut  tin-  strarilie.  aii'l  a-1  ni'ich  of  '!:'• 
jialiiiitine  as  possihle,  the  remaining  ihinl  linn^r  MTV  pur.'  t.'.^n,-. 
Such  fai  is  often  di^esteil  \vheii  other  Fats,  as  animal  fat  and  l>u:;er, 
;ire  rejected.  Nolhini:  is  ea-ier  than  to  make  an  eiiui!-;o:i  u-;t:i  anv 
fat.  suet,  or  oil.  I>ut  the  ilitliciiltv  is  !<i  make  an  emulsion  ;li;,:  \v'!l 
keep  an  indefinite  time.  If  a  pancreatic  preparation  is  u-ed.  the 
tendeiiev  is,  for  the  ferment  to  act  upon  the  fa  I.  and  .-p'.it  some  of 
it  up  into  fattv  acids.  matters  vei'v  irritant  to  tin-  stomach  and  not 
especiallv  welcome  to  the  palate.  There  are  maiiv  such  prepara- 
tions to  lie  lioii^ht:  and  when  they  are  ivadilv  [irocuraiiio  i-ji-n  !»• 
hoii^ht  as  reipiired  in  a  t'airlv  new  and  fiv-di  state. 

There    has    deeii  a  prejndii-e.  and  a  strong  one  too.  alu'oad    aliout 
prepared    foods.      l-'irst   announceil    as    "  liahy-foods  "   and    used    for 
infants,  the  pu  hi  ie  did  not  seem  to  not  ice  the  "and   invalids."  wii.'-ii 
in  manv  instances  follows    the  "  hahies."      Advancinu'  k:  owicd^.-  !-, 
howe\-er.    hreakiiiLT    down     this    prejudice,    aiheil    sjn\vlv.        A    more 
^enei'al    recognition   of    the    value   of    soluMe    carlio-h  vdrates.    ..-h,.;- 
than    cane   or   licet  su^'Jir.  on    the    par!    of    the  medicai    profe--;on.     - 
desirahle:    and    u'heii    svsteinatie    lectures   on    foo  !    and    d  eie;    • 
u'lven,  everv  voiuiu'   medical  man   will    understand    the   \a;;; 
dip-steel  t'ai'inaceoiis  maiter-.  and  I  heir    litue-sas  food  ;n  all 
weaklv  digestion,      (irape  siiu'ar  is  the  food  of   the  hodv  an.d  mu-1 
.-ulied   to  a  certain  extent   evi-rv  dav.       1    !id:u'ested    starch   !:an:>: 


I'rejiared  foods  wit  h  pre-d  iu'ested  March  mu-t  '-"me  mo 
the  dip'-t  ;ve  powers  fad  under  the  mental  -;  ra  ;n  of  ;  ;,,- 
and  the  si  ill  greater  -train  of  the  future.  I'l-fpar--,! 
kind-  thai  have  heen  suhjeeted  to  a  h:_!i  iempei-ai  iii'e. 
loods  ot  farinaceous  origin,  must  lari;'eiv  iai\e  the  p.a'-i 
in  the  kitchen.  Soln'nle  preparation-  of  meat,  ilia: 
mii-cnlar  liln'e  ha-  hei-n  I  lioi'oiiLi'h!'.  d>  'Crated,  a 
sideral'lc  ouantities  of  solul'le  cari'o-liv 


Si  MANTAI,    OK    D1KTKT1CS. 

Hy  varying  the  soluble  meat  and  the  carbo-hydrates,  variety  can  be 
_U'ot,  it'  not  a  very  wide  ratine.  Then  where  the  stomach  resents  fat 
floating  about  in  it  when  at  work,  the  fat  ean  lie  taken  when  the 
gastric  activity  is  over,  as  ereain.  or  emnlsionised  fat  artificially 
prepared.  Such  a  selieine  of  dietary  is  not  very  attractive;  but 
then  we  all  know  that  we  must  cut  our  coat  according  to  our  cloth 
— not  according  to  our  liking. 


CTLVPTKH    X. 

ARTIFICIAL    IUCKSTIYF.    .UJKNTS.-    ARTIFICIALLY     HI- 


X  KtT.ssiTY  is  tlic  mother  of  invention,  savs  tin-  n'-d  saw.  Ar.d 
failure  of  the  digestive  powers  has  led  i«  \  he  adopt  inn  of  artiticial 
digestive  agents.  First  the  chemist  sei/ed  HJH>H  the  diastase  of  the 
seedling  to  help  our  human  saliva.  Thru  In-  appropriated  t  In-  dip-s- 
tive  aiient  in  the  piir's  stomach  and  utilized  it  for  the  needs  of  man. 
Hence  pepsin  in  its  various  forms.  I'inallvon  discovering  the  func- 
tions  of  tlie  pancreas,  that  visnis  was  enlisted  as  furnishing  a  m<i.-i 
useful  recruit  to  the  ranks  of  the  artilieial  digestive  agents. 

( If  the  act  ion  of  diastase  upon  starch,  enough  has  In -en  said,  hot  h 
as  to  its  action  and  ho\\-  to  make  use  of  it  in  practice.  \<>  more 
re<piircs  to  l»e  said.  The  diastase,  or  rather  the  matter  containing 
it.  can  he  added  to  the  starchy  food:  1.  he  fore  hein^  taken  into  the 
mouth:  or.  '.'.  while  lieiiiLT  taken  into  the  mouth:  or  :!.  ;mme  iiatelv 
after  the  .food  is  swallowed  so  us  to  ud  liefore  the  stomach  hecomes 
too  sti'on<r]v  acid  for  its  operation. 


i\'e  qualities  upon  al liiiminoiii  matcna  s  xuetv.  I;  ;s  put 
up  in  a  lluid  form,  in  the  powder,  in  pills,  and  in  tahlets.  li  ;-  ;m- 
possihle  to  express  anv  opinion  upon  the  resjiective  merits  of  t  he 
liill'eren;  form-.  Tin- matter  is  to  secure  a  ^ood  an«l  poteji!  prepara- 
tion. The  pill-  and  taMe;--  have  the  advantage  of  iieinir  reai'mv 
swallovvcil.  The  [lalate  is  not  oll'ciided.  [hat  is  one  matter.  '1  ii^n 
t hei'e  is  anot her.  There  are  maiiv  iiersons  \vhose  diu'c-tion  need-;  a 
little  help,  who  are  vet  \vel!  enough  I"  visit  and  dine  out.  a!id  ;t  is 
under  these  circumstances  that  some  artilieial  digestive  :; ..  ,-  n;o-t 

neccssarv.        A    hollle    of    till  id,    is  out     of    t  he  ijUe.-t  Ion    here.    '.;;;    ; 

pepsin  pills  or  lahlcts  can  easilv  he  cai'ried  ahoii!  :  and  o;ie  -r  more 
taken  at  t  he  tahle  wit  houl  at  t  i-act  in^  at  tent  imi.  l-'or  -uch  ••:  •  <~'.;\ 
pills  and  taldets  are  adm;ra!>;v  adapted,  and  ai'e  a>-.  ••'; 

patroiii/ed.       Iiideed    !iv  such,  means  and   nica-n  ;•••-  n,;i 
e  n  a  hi  ed    to   d  i  n  e  i  n  com  pa  1 1  \   without    a  t ;  r-a  •  •  t : :  i  ^  a : :  • 
i  he  rejection,  of  careful  selection  of   their  food,  or  ii 


M-  MAM'AL    OF    1>I  KTKTK  S. 

i<>  digestive  aids: — both  exceed  ili;/iv  unpleasant  for  nervous  persons, 
\vlid  arc  verv  liable  to  In-  dvspcpt ic. 

Where  a  meal  is  taken  alone,  it  is  a  matter  of  comparative  in- 
difference  in  what  form  the  pepsin  is  used. 

Then  coiiic  jianeivatie  preparations  of  all  kinds  and  varieties. 
SD  far.  we  have  Keen  most  familial1  with  tin-  lluid  preparations 
recommended  liy  Sir  William  Robert.-.  I-'.  U.S. .  <.f  Manchester.  The 
pancreatic  lluid  ha-  a  larp'  ran;_re  of  dilative  activity.  It  trans- 
i'onns  stareli  into  °,rape  su^ar:  it  digests  albuminoids  (in  an  alkaline 
medium):  it  curdles  milk,  and  it  emuisioni.-es  fat.  The  ilitHculty 
about  it  is.  h"\vever.  that  it  is  inoperative  in  an  acid  medium.  The 
acid  stomach  lies  betwixt  the-  mouth  and  the  duodenum — the  area 
where  the  pancreatic  secret  ion  exercises  its  action.  I  >r.  Roberts  met 
this  ditVieultv  by  placing  his  Liquor  1'ancreat  icus  under  the  protec- 
tion of  an  alkaline  Lruard,  in  the  form  of  li>  or  '.'it  Drains  of  bi- 
carbonate of  soda.  I  Jut  the  soda  has  a  tilthv  taste,  and  renders  the 
draught  most  otl'eiisivc  to  manv  palate-.  It  has  seemed  to  me.  in- 
stead of  soda  and  water,  it  is  well  to  ^ive  the  pancreatic  ferment  in 
a  iriass  of  milk  with  as  mucli  prepared  chalk,  or  li^ht  magnesia  as 
would  lie  (Mi  a  sixpenci — about  tin-  sixe  of  a  male  thumb-nail.  This 
is  a  far  less  outrage  on  the  palate.  It  i<  a  preferable  form  of  alkali 
to  mv  mind.  1>\  waiting  until  the  aciditv  of  the  stomach  is  ex- 
hausted ere  j/ivinir  tliis  draught,  less  a'.kaii  i-  reniiired.  and  the 
result  is  more  certain.  The  aciditv  of  the  stomach  wanes  as  gastric, 
digestion  reaches  its  completion;  and  there  is  little  acid  left  to  neu- 
trali/e  aliout  an  hour  and  a  half  or  two  hours  after  a  meal.  Thi-  is 
the  time  to  select  for  the  artificial  pancreatic  digestive  a;_rent  to  help 
out  t  he  nat  nrai  |>ancreat  '.<•  secret  :on. 

The  -ante  principle  of  action  must  'nude   us   in    the   u.-e  of   pan- 

1  >  I 

erratic  agents  whatever  their  fonu:  and  other  than  lluid  pn-para- 
tiotis  are  aireadv  beini:  manufactured. 

Combinations  of  ; ;:"  several  diirest  ive  airents  on  t  he  "  shol-^tin  " 
principle  are  iai'^elv  sold.  I'liplivsioloLfica!  a-  they  appeal'  thev  cer- 
tainlvare  often  useful.  "If  the  .  -  misse-,  t'other  hits."  That 
is  the  principle.  If  the  contents  o!  the  -tomach  lie  still  acid,  then 
the  ])cp-in  come-  in  u-'-ful.  If  the  fooii  be  pa--:iiLT  the  ]iylorus,  and 

eomil:^-   into  eolil        '  '  ;'.     :  le-  of   t  hi'   bile,    t  lie|i    the 

pancreatic  product-  arc  ready  for  action. 

Such  th''ii  are    i          •  '.'.  the  artitic  ;     i]  _•••  -•  ve  avfent-. 

\o\v  a-  i"  [iredi;_re>ted   1'uods.       Mnou^h  ha-  been    .-aid  about   piv- 


a  rui«-.  a  iv  !,au.-fii; 
fill,  i'Ut  inv  i-xjM-r. 
n«it  ;:ivui\  «•  th--  i1"!. 
]i;<>r>-  I'avuraii!.'  t" 
u''ijr.-u<i!;a!>.''.  i",  ••:. 
':•••  ii:a<i«'  |ia.ata:'!'-. 


I'l-ln-ral  .-ta'f  <  •:'  \v--aK  '.  —  . 
lift\Vc.-:i   ra  ----    V,':..-!  '.-    lii.-   -'.  .Ili 

hvt-r  is  t'i  :>".ai::--.       I  ::  .-tat--*   •• 


SS  MAM   AL    OK    HI  ATKTK'S. 

Sonu'  description  of  them  becomes  essential,  as  there  are  eases 
where  they  are  required.  Hut  whether  great  gastric  irritability 
existing  is  an  indication  for  their  use  is  a  moot  matter.  1  am  not 
aware  that  it  is  pleaded  that  peptones  sit  more  easily  upon  tho 
stomach  than  proteids,  though  it  may  eventually  turn  out  that  such 
is  the  case.  Here  it  is  rather  a  <|ucsti<m  of  hulk  than  of  anything 
else.  Small  quantities  at  once  of  whole  heef  tea.  with  some  baked 
Hour,  malt  extract,  or  milk  with  or  without  some  soluble  carbo- 
hydrate, should  be  tried.  Kspecially  in  gastric  catarrh  is  this  desir- 
able. If  anything  approaching  solid  food  be  taken  then,  as  it  is 
rolled  over  :n  the  stomach,  it  becomes  coated  with  mucus,  and  so 
forms  an  utterly  indigestible  mass.  Here  peptonised  milk  niav  be- 
come useful  as  no  longer  undergoing  or  requiring  the  curdling  which 
might  transform  ordinary  milk  into  something  of  a  solid.  In  gastric 
nicer  predigcsted  food  would  pass  readily  through  the  stomach  and 
occasion  little  movement,  and  would  do  away  with  the  pain  caused 
by  the  muscular  contractions  dragging  on  the  base  of  the  ulcer.  The 
presence  of  the  acid  of  the  gastric  juice  irritates  the  raw  surface, 
and  vomiting  relieves  the  stomach  at  mice  of  both  acid  and  move- 
ment, and  so  immediate  ease  follows.  The  circumstances,  under 
which  resort  to  [in-digested  food  is  indicated,  can  only  be  broadly 
spoken  of  here,  and  must  in  each  ease  form  the  subject  of  private 
judgment  upon  the  part  of  the  medical  attendant.  After  such  cau- 
tions and  qualifications,  some  account  niav  be  ^iven  of  the  means 
of  preparing  them:  following  upon  the  lines  laid  down  by  Sir 
William  Roberts 


In  peptonismg,  or  partially  digesting  fond  by  means  of  Liquor 
Pancreatielis,  it  is  important  to  remember  that  the  liquor  must  not 
be  added  to  food  of  anv  kind  at  a  higher  temperature  than  1)0-' 
Kahr.  This  temperature  can  be  estimated  with  suHicient  accuracy, 
should  no  suitable  thermometer  be  at  hand,  bv  last  MIL:'.  If  too  hot 
to  sip  without  scaidinir  the  mouth,  it  would  entirely  de.-trov  (In- 
activity of  (he  liquor  panereat  icu-,  and  mu<t  be  allowed  to  cool  to 
that,  point  before  ,-ueh  addition  is  ma  le.  Tins  rule  will  hold  Li'ood 
with  oilier  pancreatic  preparation-. 

Peptonised  Milk.-  A  pint  of  milk  is  diluted  with  a  quarter  of 
a  pint  of  water,  and  heated  to  a  temperature  of  about  1  )ii  Kahr., 
(Mi  (  '.  ).  Or  the  diluted  milk  mav  he  di\  ided  into  t  \\  o  equal  portions, 
one  of  -i\h:ch  may  be  heated  to  the  boiling  point,  and  then  added  to 


ARTIFICIAL    D1C.KST1VK    A<,KNTS.  ^'.1 

the  cold  moiety;  the  mixture  will  then  be  of  the  required  tempera- 
ture. (\\earenot  told  what  is  the  temperat  lire  of  the  cold  portion. 
but  we  may  assume  it  is  below  M>  l-'ahr.)  Two  or  three  teaspoon- 
1'nls  of  liipmr  pancreatieus.  together  with  ten  or  twenty  grains  of 
bicarbonate  of  soda  (about  half  a  small  teaspoon fu  1 )  are  then  mixed 
therewith.  The  mixture  is  then  poured  into  a  covered  jiiir.  and  the 
jitir  is  placed  in  a  warm  situation  under  a  cosey  to  keep  up  the  heat. 
At  the  end  of  an  hour,  or  an  hour  and  a  half,  the  product  is  raised 
to  the  boiling  point  for  two  or  three  minutes  in  order  to  arrest  any 
further  digestion.  It,  can  then  be  used  like  any  ordinary  miik. 

The  object  of  diluting  the  milk  is  to  prevent  the  curdling  which 
would  ot  herwise  occur,  and  greatly  delav  the  peptoni>inir  process* 
The  addition  of  bicarbonate  of  soda  prevents  coagulation  dnnm-: 
the  final  boiling,  and  also  hastens  the  process.  The  purpose  of  the 
final  boiling  is  to  put  a  stop  to  the  ferment-action  when  tin-  has 
reached  the  desired  decree,  and  thereby  to  prevent  certain  ulterior 

e  ha  Hires  which   Would    render  the  product    less   palatab'c.        The   de-Tec 

to  which  the  peptonisinir  change  has  advanced  is  bc-t  ascertained  by 
the  development  of  a  bitter  llavour.  The  point  aimed  at  is  to  carry 
the  changes  so  far  that  the  bitter  taste  is  distinctly  perceptible,  but, 
is  not  unpleasantly  pronounced.  The  extent  of  the  peptoni-m:^ 
action  can  be  regulated  either  by  inereasinLT  or  decreasing  the  dose 
of  hipior  paiicreat  iciis  or  by  increasing  or  decreasing  the  time  d  tiring 
which  it.  is  allowed  or  permitted  to  operate.  liy  ski  in  mini:  the  m ;  Ik 
beforehand,  and  restoring  the  cream  after  the  final  boir.n^',  the 
product  is  rendered  more  palatable  and  more  milk-like  ;n  appearance. 

Peptonised  Gruel. — (iruel  maybe  prepared  from  any  of  the 
numerous  farinaceous  articles  which  are  in  common  n.-e,  wheaten 
Hour,  oatmeal,  arrowroot,  sairo,  pearl  barley,  pea  or  lentil  llour.l 

The  irruel  should  be  well    boded  and  made  thick  and  strong.       '' 
is  then  poured    into  a  covered   JULT  and  allowed  to  coo]  to  a  tempera- 
ture of  about    14"     l-'ahr.       Li'pior  panereat ieus  is  then  ad'ieil,  :ti  the 
proportion  of  a  tablespooiiful   to  a   p;nt    of   ^ruel,  and    the  jnL 
warm    under   a    cosev  as  before.       At   the   end    of  a    couple   < 
the  product   is  boiled   and    finally  strained.      The   action    of   the  pan- 
creatic   extract  on  irniei    is    twofold;    the   starch    of    ; 

:  Ma v   i ioi   i  he    mat  ter  e-o  1'ar   to   expla  in    I  In-    i  < M> iy  o  ;_••-•  i : ,, 
dilute,!  \vit  1 1  an  alkaline  \vatei'  as  coin  |  >a  rei  I  i  o  |  ii.o  n  mi  1 1\ 

t  In  accui'dallce  wit  li  \\  I  i;il    li;i-  1 u  ;i  i  I  a  !•  'iiu'  in-i-!'-il   1 1 

h;i-    aii-eaily    b«-rii  expo-eil    to  a    liin'li  li-ni|n-ral  lire  i-  tu    !,  .'-n 

here. 


9<»  MAM'AL    OK    DIKTKTK'S. 

verted  into  sujrar,  ami  the  allmminoiil  matters  an-  peptonisod.     The 

conversion  of  the  starch  causes  the  •jrucl.  however  thick  it  mav  have 
liceii,  at  Martini:,  to  become  quite  thin  and  \vatcrv.  lVptoni/,ed 
•Truel  is  not  LTenerallv.  by  itself.  acceptable  food  for  invalids,  but  in 
conjunction  with  peptonised  milk  (peptonised  milk-Lrrnel)  or  as  a 
l»asis  for  pcptonised  soups,  jellies,  and  blanc-maiii^es  it  is  likely  to 
prove  valuable. 

Peptonised  Milk  Gruel. — This  is  the  preparation  with  which 
Dr.  Roberts  has  had  the  most  experience,  ami  with  which  lie  has 
obtained  the  most  satisfactory  results.  It  mav  lie  regarded  as  an 
artificially  digested  bread  and  milk,  and  as  forming  bv  itself  a  com- 
])lete  and  highly  nutritious  IViod  for  weak  digestions.  It  is  very 
readilv  made,  and  docs  not  require  the  thermometer.  First,  a  ^ood 
thick  irruel  is  prepared  from  any  farinaceous  material.  The  irruel 
while  still  boiling  hot.  is  added  to  an  e<|ual  (plant  it  v  of  cold  milk. 
The  mixture  will  have  a  temperature  of  about,  140  Kahr.  To  cadi 
pint  of  this  mixture  two  or  three  teaspoonfuls  of  liquor  pancreat  ieus 
and  t  went  v  grains  of  bicarbonate  of  soda,  (half  a  small  tcaspoonfnl) 
are  added.  It  is  then  kept  warm  in  a  covered  jui:  under  a  cosev  for 
a  couple  of  hours,  and  then  boiled  for  a  few  minutes,  and  strained. 
The  bitterness  of  the  digested  milk  is  almost  completely  covered  in 
the  peptonised  milk-^ruel, — and  invalids  take  this  compound,  if 
not  with  relish,  without  the  least  objection. 

Peptonized  Soups,  Jellies  and  Blanc-manges. —  l>r.  Uob- 

ert-  has  sought  to  _tri\e  variety  to  peptonised  dishes  by  preparinir 
soups,  jellies,  and  blanc-maniU's,  containing;'  peptoniseil  elements. 
These  contain  a  larire  amount  of  digested  star<-h  and  iilbuininoiil 
matter,  while  possessing  excellent  flavour,  and  which  the  most  deli- 
cate palate  i-ouid  not  accuse  of  ha\inu'  been  tampen-d  with.  Soups 
were  prepared  in  two  wavs.  The  first  wav  \\'as  to  add  what  cooks 
call  "stock  "  to  an  eipiai  quantity  of  peptonised  ^riicl.  or  peptoni-ed 
milk-Lrniel.  A  second  and  lieitcr  \\'ay  was  to  use  peptonised  lyruei. 
which  is  (jiiite  thin  and  watery,  instead  of  simple  water  for  the  pur- 
pose of  extract!  HIT  shins  of  beef  and  other  materials  cm  ployed  for  the 
preparation  of  soup.  Jellies  were  prepared  simply  by  adding  the 
dm-  quantity  of  p-chitine  or  isiiiLfla.-s  to  hoi  peptoni/ed  u'ruel.  and 
lluvoiinntr  'he  m i \t  11  re  accordiiiLT  ' o  taste.  Dlanc-ma n^cs  were  made 
bv  treating  pcptoni>ed  milk  in  the  same  way.  and  then  adding 
cream.  In  prepannuf  all  thc-e  ili-he-  ,t  i<  absolutely  necessary  to 
complete  tiie  operat  ion  of  peptomsinu'  the  ^niej  ,  ,r  milk.  e\  eu  to  t  he 
lina!  boi'inLr  before  a'Mini:  the  stilTeiiinu  inirredient.  I-'or  if  Honor 


Airi'iKK  i  \i.  !>!<;KSTIYK    M.KVIX.  :•] 

pan>Teai  I'Mis  l)c  allowed  to  act  on  tin-  Ll'elat  1  lie.  tin-  '_feiat  '',">•• 
undergoes  a  process  of  digestion,  and  its  power  of  -cttMi'j'  <>r 
iiiur  is  nt tcri v  abolished. 

Peptonised  Beef  Tea.    -Hail'  a  pound  <>!'  tin 
beef  is  mixed  with  ;i  pint  of  water  and  twenty  grains  of    bicarb, 
of  soda.      This  is  simmered    for  an    hour  and  a  ha.f.       \\'ln": 
cooled  down  to  140     Kahr. .  a  tabicspoonful  of  ;  he  im  M.  .)•  pan-  n-at  ..• 
is  added.      The   mixture   is  then    kept    warm    under  ;i  cosey  for   tuo 
hours,  and  occasionallv  shaken.      At  tlie  end  of  this  time,  ihr  liquid 
portions  arc  decanted,  and    boiled    for   live   minute-.-.      I'.eef  tea    pr-- 
pared    in    this   wav  is   rich    in    peptones.       I:    contain-  about    J.'i  per 
cent,  of  organic  residue,  of   wli;ch    more  than    three-fourth-  eoii-i- 
of    peptone^,    so    that    its    relative    value    in    regard     to    nitro^eni.-ed 
materials  is  about,  equivalent  to  that    ot    milk.      \\  hen  seasoned  with 
salt  it  is  scarcelv  distinguishable  in  taste  from  onlinarv  beef  tea. 

Another  way. — One  pound  of  tineiv  minced  lean  beef  j~  mixc.i 
with  one  pint  of  water,  and  simmered  for  an  hour  ami  a  half.  Tin- 
result  MIL:  beef  tea  is  then  decanted  oil'  into  a  covered  jiii:'.  The  un- 

(lissoived  beef  residue  is  beaten  With  a  Spoon  into  a  I'll,  p  or  pa-tc, 
and  added  t<>  the  beef  tea  into  the  covereil  ju^(wlioie  beef  tea). 
\\"hcn  the  whole  is  <-ooled  down  to  MU  i-'ahr.  (or  when  it  i 

enouirh  to  be  tolerated    by  the  tuoutlf)  a  tables] nfui    of   the   , 

paticreatieus.  is  adiU'd,  and  the  whole  well  stirred  together.  The 
covered  jii'_r  is  then  kept  wai'in  under  a  i-nscv  for  two  hour-,  at  the 
end  of  tins  time  the  content-  of  the  juir  are  boiled  brisk  Iv  for  t  \\  o 
or  three  minutes,  and  (inallv  strained.  ;;  is  then  rcadv  for  u-e. 
The  extreme  solu!)ilitv  of  digested  product-,  whether  r-tarch  or  a.- 
htiminoicls.  detracts  from  their  acceptability  |o  the  heaithv.  T  • 
them  tiiev  a|)|iear  thin  and  waterv.  tln-v  miss  the  scii-e  of  .-uli-!:in  •<• 
and  solidity,  which  is  cliaracteristic  of  their  ordinary  food.  Ui;1  '» 
the  weak  in\  a!  id  wit  bout  appetite,  this  sense  of  -ub-taiice  or  t  ii  \-  -\\>-' 
MIL;'  is  generally  an  objection,  and  they  take  with  more  ea-c  a  M  a.  :- 


lias     beell      lliade.      then     the     Si 

reli-hed. 

The    Use    of   Liquor    Pancreaticus    as    an    Addition    to 
Food   shortly   before   it    is   Eaten.     <  crta 
useii     i»\     invalids,    farinaceoiis    j-ruci-,    m;,i\.    !ii-c:l4  ;'i 
tla\  on  red  with    tea.  or  ci  ilTee.  o 


MANUAL    OF    DIKTLTM'S. 

up  with  the  warm  food  as  soon  as  it  comes  up  to  table.  And  such 
is  tlio  activity  of  the  preparation  that,  even  as  the  invalid  is  enpisjed 
in  eating — if  lie  eat  leisurely  as  an  invalid  should — a  change  comes 
over  the  contents  of  the  cup  or  basin:  the  Li'ruel  becomes  thinner, 
the  milk  alters  a  shade  in  color,  or  perhaps  curdles  sot'tlv.  and  the 
pieces  of  bread  soften.  The  transformation  thus  he^un  s^oes  on  for 
a  tune  in  the  stomach,  and  one  may  believe  that,  before  the  iiiistrio 
acid  puts  a  stop  to  the  process,  the  work  of  digestion  is  already  far 
advanced. 

The  food  should  be  cool  enough  to  sip  before  the  Liquor  1'nn- 
ereaticus  is  added,  else  the  ferment  is  killed. 

Peptonised  Enemata. — Such  peptonised  milk-irrnel  as  has 
been  described,  is  adm irably  adapted  for  cneinata.  Here  the  palate 
has  not  to  be  considered,  and  monotony  is  not  distasteful.  IVp- 
tonised  beef  tea.  with  some  soluble  carbo-hydrate  may  he  used  at 
times.  l)iit  the  fat  in  the  milk  makes  the  milk-uTiiel  more  desira- 
ble, in  theory  at  least:  for  how  far  fat  can  be  taken  up  by  the  larsjje 
bowel  is  a  matter  on  which  the  writer  knows  nothing  personally, 
nor.  on  enquiry,  can  lie  lind  anything  to  favor  the  view  of  fat- 
absorption  by  the  lanre  intestine. 

There  lies  no  objection  to  peptonised  preparations  for  enemata 
on  account  of  their  taste.  and%an  enema  of  peptonised  beef  ten, 
with  anv  of  the  prepared  foods  consisting  of  soluble  carho-hvd rates, 
would  be  easily  prepared  in  any  household,  however  humble. 

There  are  other  preparations  than  tluid  pancreatic  preparations, 
and  the  following  are  from  the  instructions  furnished  by  Messrs. 
Faiivhild.  This  form  has  its  pancreatic  preparation  in  the  form  of 
a  powder  —  I'J.ft rui't a ni  I'd n/-/-riit i<.  It  is  sold  in  u'la-s  tubes,  each 
containing  live  grains  of  the  Fxtraetum,  and  fifteen  grains  of  bi- 
carbonate of  soda.  (Thev  are  sold  in  boxes  of  one  do/en).  The 
contents  of  one  tube  will  digest  one  pint  of  milk  in  half  an  hour. 

The  procedure  is  simple:— "  Into  a  quart  bottle  pour  \\  pint  of 
milk,  a  (jiiarter  of  a  pint  of  water,  and  one  peptoiiisinir  powder. 
Let  this  stand  for  thirty  minutes  in  water  as  hot  as  the  hand  can 
bear,  and  then  boil  for  two  or  three  minutes.  It  is  then  ready  for 
use.  and  should  be  kepi  in  a  cool  place. " 

In-tead  of  testing  the  temperature  by  sipping.  -  I  >r.  Roberts' 
plan  —  Messrs.  Fairchild  prefer  the  hand:  either  is  a  trood  ;1|id  ready 
test.  From  the  evidence  Messrs,  l-'ain-hild  have  lieen  alile  to  collect, 
t  hey  are  st  ronirly  of  t  he  opinion  that  peptonised  food  is  more  readily 
borne  and  tolerated  by  the  stomach  than  food  not  prcdinvsted.  They 


n 


s;iv    (if    peptonised    milk-    "It     is    retained 

cspeciallv  of   the  digest  he  tract.  when    e\ervt  hiii'_r  «•  - 

jeeted."     Time  will  tdl  if  this  sanguine  \  ieu    :-  wi-j  founded.       1  •>:• 

tile     peptoniSIDM;     of     llleat     their     direction-     are;     "To     h:iif     ;i    I'!, 

whole  beef  tea  and  half  ;i  pint  of   water.  thirt\   ^raii:-;  c-f    K\;  ra--'  n  m 
1'ancreat  is.  an<l  twentv  grains  of   bicarbonate  of   -oda.  ai.d  ke.<p  : 
warm    place  not  over  Ho*    I-'.,  for  three  hour-.  ai;'l  the:,  in    I,.,;; 
kill   anv  remaining   activitv    in    I'ancreat;'-   Kxtract."     Nida  -•  '-m-   a- 
essential  to  the  action  of  trvpsin  a-  aei(l  is  to  the  action  nf  p.-i.-m. 

Tlie  use  of  peptonised  fooils  became  vcrv  extensive,  soon  af;< 
Sir  \Villiam  Roberts  introduced  them  t<i  the  notice  of  the  puii/.-; 
but  the  demand  is  now  much  less.  Whv  is  thi.-l'  l'roiia!i!\  out- 
matter  is  that  those  practitioners  who  love  to  dal>l>!e  in  the  \erv 
latest  novelty,  had  ]>eptonised  food  pi-epared  in  manv  eases  wtieiv 
onlinarv  food  would  have  served  eijiiailv  well,  and  so  LZ'ave  i!:-- 
friends  and  nurses  of  manv  invalids  a  "ffeat  deal  of  uniiecessarv 
trouhle.  Then  other  novelties  cropped  up  and  liu-t!ed  pep;.  .M  /.-  -d 
foods  out  of  the  memories  and  minds  of  the  said  novei-lnn:t  :n^ 
practitioners.  That  is  part  of  the  explanation.  Another  part  : 
tliat  the  resultant  products  were  not  palatable,  because  the  in-tnic- 
tions  were  not  rigidly  cai'ried  out.  A  tine  in.-trumeni  in  the  hand- 
of  a  careless  fellow  is  soon  put  out  V»f  working  order;  and  the  finer 
the  instrument,  the  sooner  disaster  is  induced.  The  method  of 
peptonism^  food  is  a  matter  of  precision,  1st.  the  n^\\{  \  •mperature 
—  liicrh  enouLrh  to  permit  of  the  ferment  readily  acting.  :md  vet  •...; 
too  hi^h  to  kill  it.  If  too  hi.Lrh  i"'  peptonisiiii:  i>  possibh'.  if  too  ;«.\\ 
the  iliifest  i  ve  a^enT  is  inoperative,  and  no  peptonisin";  follows.  •.'•:. 
The  neglect  of  raisiiiLC  the  lluid  to  the  hoi;  at  the  proper  time. 
''The  hotter  the  oven  the  shorter  the  time."  is  an  axiom  in  co,  .k::  _. 
If  the  lluid  was  kept  warm  under  the  eosey  the  time  to  raisi  'o 
the  boil  comes  earlier  than  it  does  when  some  (  .....  line;  <  .....  ur-.  I: 
the  time  to  raise  it  to  tlie  l>oil  is  delayed,  t  hen  the  bittei-  ia- 
coinplete  digest  ion  is  brought  out.  aii'l  so  the  resultant  pi-oiin-'l  .'•• 

oiTen.-i  Ve   to   the    palate. 

It  is  easy  to   see   how   earelessne.-s.  or   perhaps   to   be   ni,.r. 
how  the  want  of  careful  exact  it  ude  led  t"  ii'-ii-e  of  pepti 
If  these  were  only  used  when  it  is  understood  t  hat  t  he  en- 

it  would    follow   that    pi-oper   care    win;!'     '•»•    taken.       \:-- 
follows    upon    use.  and    dabbling   in    pep'-misin^    food 
eurio>ii  v  or    keep  somebody   •  nit    >  >'i    \ 
valuabie  measure  intu  disrepute,  aand  con-dpi.  •, 


'.i-l  UAM  AI,    OF    MKTKTH'S. 

Iii  ordinary  cases,  prediirestod  carbo-hydrates,  arc  enough  with 
whoie-meat  broths,  and  mills  with  selt/.cr  water,  in  small  (|iiantitics 
at  onrc.  alternating  \vith  malt -extract  for  varictv.  If  such  dietary 
is  insuilicieiit.  and  life  i-  (jiiivcriii^  in  the  balance,  then  sonic  re- 
sponsible person  inu.-t  he  put  on  to  do  the  peptonisinir,  \vitha  full 
sense  and  consciousness  of  the  ^rave  responsibility  of  his  or  her 
action.  If  this  were  done,  then  the  practitioner  could  rclv  upon 
his  weapon  as  bein<:  well  forced  and  tniM  worthy.  l!ut  to  set  a 
nieddlesonie  fool  to  work  peptonisiiiLT  food,  is  |o  inaugurate  a  solemn 
farce,  and  if  the  case  he  ivallv  a  irravc  and  serious  one.  such  pro- 
cedure is  little  less  than  manslaughter,  and  deserving  of  the  most 
severe  censure.  If  a  medical  man  does  not  possess  sullicient  acumen 
to  discriminate  his  agents,  he  is  not  tit  for  the  post  he  has  a.-s.umcd. 
And  if  he  cannot  exact  military  ohcdicnce  from  his  subordinates, 
he  should  dismiss  them  from  the  service,  as  a  ( leiieral  does  an  in- 
competent soldier:  and  if  be  cannot  do  that,  lie  should  dismiss  him- 
self from  the  irciicralship  of  the  cast — and  his  resignation  would  bo 
the  hot  plan  f' T  ail  concerned. 

With  propei-  care  and  precautions,  peptoniscd  foods  arc  a  most 
valuable  aid  in  manv  cases,  especially  where  there  is  anv  morbid 
condition  of  the  >tomaeh  pre.-ent.  Thev  require  little  or  notiiniL;'  of 
natural  digestion,  and  sit  easily  on  the  stomacb:  but  then  such  food 
rcMiures  to  be  made  with  as  much  can1  as  is  rc(|iiisitr  m  putting  to- 
gether the  work-  of  a  watch-  if  it  has  to  ^o  well. 

An  attempt  to  provide  a  peptonised  preparation  which  only  re- 
quires -omc  hot  thud,  and  so  dispense  with  hou.-ehold  peptonisin^, 
has  been  maile  in  "  Solu  lile  Kood.  " 

With  this  last  remark.  whi"h  indeed  applies  hroadlv  to  ail  culi- 
narv  preparations,  but  specially  to  pcjitonised  foods.  Par!  I.  of 
tbi.-  work  lit  1  v  I'oncludcs.  A  knowiedu'e  of  \\liat  food  is.  of  what  it 
consists  cbeinicaiiv,  of  its  destiny  ill  the  body,  of  the  ctTects  of  i-ook- 
in^'.  and  the  d.lTereiit  poi'iions  of  the  digestive  act.  must  const  ilnt(! 
the  I  i;i--is  or  fou  nd  at  ion  of  all  dietetics,  and  m  u.-t  lie  t  horou^hi  v  mas- 
tered in  detail  liefore  t  lie  aet  nal  liict  :.•_;•";'  a  -.••!<  [ler-ou  can  besafelv 
ajiproachcd.  It  .  -  the  \\  ant  of  -'iicb  km  >\\  cii^-e  •  as  hit  hci'to 

iiamperci'i  the  profes-ion  in  dealing  \\ith  the  mailer;  lea '.HILT  each 
practitioner  sinu'lc-Iiandei]  to  |o  o\vn  experience  an  experi- 

ence often  leading  h;m  in  a  manner  \\'h:ch  remind-  me  of  a  cicr^'v- 
man's  answer  when  a-ked  if  a  certain  parishioner  followed  his  con- 
science.— "Oh  \  e-.  "  wa-  the  |'epl\  .  "  c  foi  ows  ll  IS  cimscielice  Very 
much  ;  n  '.lie  \\  a  \-  1  M  •  ma  \  be  -aid  to  •  o.  ;o\\  [•  \\'ben  he  dn\'e- 


it  in  front  of  him!"     A  man,  to  some  extent.  mak<-- 
as    h"'   pics,  tentat ivc]  v,  on    certain    line-   laid   down.  !,;;• 
how!'      The    fashion-    which    have    swa\ed    i  he    dietarv    <•'. 
room.  demonstrate  that    no  iruidiiiL:   |irinci|ile   wa-  :n  a.-i 
matter.      \'cal    broth  and  eel  broth  had    vieided    to  calve.-'  MM.-    '.-.,•.. 
when  inv  professional  experience  first   be^an:    then  tha'  i_-;iv>-  \\a\   :•• 
milk  and  seh/.er  water.  o\  er  \\  hn-h  beef  tea  u-urped  ;t  bane!''.il  ;  ••.  ran: 
\vhieli  it  still    liolds.       I5ut  the  facts  are  -iowlv  underminim.:  it-     <.;'<•. 
and   common   sense,  illumiiietl    by  scientific   knowledge,  i-  hombard- 
iiiL;-  its  fortress,  and.  before  lon;_r.  \\  c  n.av  fairlv  hope,  its  ;;',-•'..!      ;,•  .• 
]iret(.'iisions  to  be  a  snstainini:'   fooil    \v,ii    \»-  abandoned,  and   a    -afer 
and    .-onndcr   jiosition  takeii  up.  vix.:— that    it    is    (a-  ordinariiv  pre- 
pared )  a  stimulant  vehicle,    plea-ant    to  the    palate  for  -oni'tile  <-arho- 
hvdrates — no    mean    position  l>v  anv  nu  an-  for  ,;  \»  hold  1      Mrior  '.: 
knowledge    in    the    making,    and    "  ki!(»\vied^e   LTI'O\VS.    but    \\v-iiom 
lingers."  as  is  evinced  in  a  piece  of   instruction  in  a  medical    journal 
which  came   under   inv  notice,  while    penniiii;'   tin-  chapter.      >he.; 
ti.-h    there    is  a<lvocated    a-   a    food    for   the    diabetic,   and   e-peciai.\ 

ovsti'l'S.        ?\d\V   the    ^'I'eat    lillik     of    the    oVStel1  ( like  >oine    other    -he.! 

ii.-h).  consists  of  its  liver,  which  is  crammed  with  Ldyco^en.  or  animal 
starch.  How  such  a  curiou-  and  [lernieious  error  could  ha\e  foiini; 
its  wav  into  a  respectable  medical  journal,  is  one  of  those  th.nu- 
whi<di  Lord  J  )u nd rear \'  decided  "  No  fellow  can  understand.  "  \\  hen 
dietetics  are  properlv  taught  in  our  medical  schools,  an>i  each  ineii;- 
cal  ,-tudent  is  made  to  understand  the  chemical  compo-ition  and 
utilitv  of  each  article  of  our  dietary,  a-  careful!)  as  lie  .-  laii^h;  the 
action  of  each  unit  of  'he  Pharmacopeia,  he  w.ll  hannie  h:-  HUM!  .-,- 
skilfiillv  as  he  wield-  each  medicinal  aiTem.  Aip't  ihen.  wii--n  :,•• 
can  iio  this,  lie  will  achieve  results  which  mav  an'reealnv  .-ni'pr 
ot  hers  as  well  as  him-cl  f. 

M\  erv  ,-ick  per.-on  is  a  dvspcpt  ic  i'^r  t  he  t  ;me  bein'_r:  and  •••.  h- 
it     :.-    the    dvspep,-;a    of    a'-ule    di.-ea-c.    or    ot    chronic    iii.-ca-c.    • 
trouble    collected    with    the    stomach    it-e'.f.    llie    |uc.i;,-a 
ha-  ilai'iv  to  encounter   impaired  litres!  ive  p.  i\\ei-       .-.. 
pa'  lent-  at  all  !     A  lid  a  knowledge  of  d  id  c; ' 
ouaintance   witli    Materia    Meclica;    and    Tiiei-apeu':c 
neglect  one  u!'  the  other,  than  a  ladiier  can  cun.-i.-i  u!    o:. 
and  ruii'j's. 


PART  II. 


CHAPTER    XI. 

FOOD    IN    INFANCY. 

HAYING  discussed  tin.1  subject  of  Food,  in  its  entirety,  it  now 
becomes  possible  to  enter  upon  the  practical  application  of  this 
knowledge. 

When  the  babe  is  newly  born  it  was,  and  in  sonic  cases  may  still 
be,  customary  to  put  something  into  its  mouth;  commonly  some 
sugar  and  butter. 

The  child  had  had  a  long  last,  it  was  pleaded,  and  the  welcome 
to  the  little  stranger  could  best  take  the  form  of  some  nourishment. 
The  motive  was  good,  at  any  rate.  "  At  birth  the  stomach  and 
liowels.  not  having  been  used  for  the  purpose  of  digestion,  contain 
a  C|Uantnv  of  mucous  secretion — nieconium — which  requires  to  be 
removed  before  they  can  enter  upon  then-  function.  To  effect  this 
object  Nature  has  rendered  the  first  portion  of  the  mother's  milk 
purposely  watery  and  laxative;  and  on  the  part  of  the  infant  nothing 
further  is  required  than  to  allow  it  to  follow  its  natural  instinct  and 
suck  it  in.'7  So  savs  I  >r.  Andrew  Combe  m  his  famous  treatise  on 
"Digestion  and  1  )ietct  ics.  "  Laxatives,  other  than  this,  a  IT  not  re- 
quired. He  has  some  more  remarks  whieh  seem  to  me  to  be  worth 
(jUotat  ion. 

"At  birt  h  the  stomach  is  feeble  and  as  yd  unaccustomed  to  food. 
its  era  villas  are  consequently  easily  sat  istied.  and  frequent  1  v  renewed. 
A  healthy  infant  seeks  the  breast  with  avidilv.  but  sucks  little  at  a 
time.  It  leaves  an  interval  for  thoroughly  digesting  t  he  lit !  le  which 
it  has  swallowed ;  after  which  its  appetite  revives,  and  a  fresh  supply 
is  demanded  in  language  which  no  mother  can  misinterpret.  I  Mir- 
ing t  he  lirst  MlOIlt  h  appet  ite  ought  to  be  the  mot  her's  M-n  •,!,,  |],  oll'er- 

iiiLT  the  breast,  and  if  she  know  how  to  read  the  expression  of  her 
infant  aright,  she  will  want  no  other.  .\t  that  early  age  1  hen- uu^'iit 
to  be  no  fixed.  t;ine  t'or  !_rivMi:_r  noi  i  111  ','.  'I  he  stomach  cannot 


FOODS    IN    INFANCY.  '.'7 

be  tints  satisfied.       In   one  child    digestion  mav  be  slow,  an  1    i 
tcrval    IK-   c()lisc(|U01itly  too   short;     in    another    it    may  be  'i'1'1' k.  an  1 
the  interval    too   Ion.;.      But    the  active  rail   of   the    infant    i-   a   .-'/.m 
which  need  never  be  mi-taken,  and  none  e|.-e  ouirht  to  lie  listened  (<>.'' 

Overfeeding  i-'.  however,  the  danger  in' r  1. 1 1  -'.he   hi. Ms:    and 

mo-t  of  the  troul'les  of  early  infanev  are  clue  to  tin-,  a-  en!:.-,  howel- 
irritation  and  diarrho-a.  The  earminatives,  aroinat  i*--  and  antacid-, 
so  frequently  u'iven  t<>  infants  are  required  niainlv  in  consequence  of 
errors  in  feeding.  \\'e  must  not  put  out  of  >i'_dil.  however,  liie  fact 
that  any  derangement  of  the  maternal  health,  anv  ,m proper  food 
on  her  part,  even  a  mental  emotion  ma\  .-o  all'cct  the  mhk  as  to 
alter  its  qualities.  This  is  a  well-known  fact  with  mother.-.  |-"ur- 
ther.  if  a  child  is  const  ipated.  the  [ileasantest  method  of  correct  ML:' 
the  liowels  is  to  ^ive  some  mineral  la\ati\e  to  the  mother:  and  of 
ail  these  the  phosphate  of  soda  su^csls  it-elf  on  phv.-iouiLfical 
grounds.  The  dose  to  In-  !_n\eli  to  the  mother  which  i-  siitlic;ent  to 
inllueiice  the  clulil  isusuallv  not  so  iarj'e  as  to  alTf-t  he1,'  mii'di. 
The  mother's  milk  is  usuallv  ((tiite  sutlicient  for  the  iir-1  nine 
months  of  existence.  \oi-  need  the  mother  he  specially  fed  for  the 
purpose  of  stitlicient  lactation. 

Of  old.  if  the  mother  was  removed  hv  death  or  from  any  iea-oii 
rendered  unei|tial  to  sticklinn'  her  liahe.  a  wet-nurse  was  procured. 
I''or  the  purpose,  a  mother  in  a  humhie  po-;t:on  of  life  was  u.-uailv 
selected.  lint  "the  health  and  usefulness  of  country  nurses  arc 
often  utterly  ruined  liy  their  transplantation  into  the  families  of  rich 
and  luxurious  employers/'  said  ('omhe. 

The  "wet-nurse'"  is  now  almost  a  tiling  of  the  p:i-t.  and  ln-r 
modern  substitute  is  the  "  feeding-bottle."  Hut  as  much  care  is  re- 
quired \\'itli  the  one  a-  with  the  other.  IVrfc.-]  clean! ; tie--  i<  reijiu- 
site;  scalding  wit  li  hot  watei-  con tainiiiL;'  some  -uda  .-In  MI  ,>  i  !»•  i  •;•:!'•:  ;-,.d 
after  each  ll<e  of  the  bottle  the  hot!  !e.  t  he  tube-,  and  I  in1  n  '•:;'  ''•.• 
piece.  The  milk  i-  usually  furnished  bv  the  cow;  and 
matlcrof  indilTereiiee  how  that  cow  is  fed.  If  li'iveii  breui'i  •  -. 

lush  'jra-s  and    othei-   fund    which    lend-  to  a  lai'u"1'   ou:r 
the  milk  of   cows  MI  fed    is   apt    to   disiu'ree  with  tiic  ;•  ;'aiit.      t  •• 
(ptentlv  in  most  dairv-\'ards  a  cow  i-  >jtei-ia':\    fed  for  ;h' 
of   milk    for  baliie-.      Sometime-  the    mnk  of  one  eo\\-  i,  .- 
a  babv  I'm1  no  apparent,  or  o-|i'n-ibie  rea-on.  and    \\.< ••: 
change  the  milk      a-  it   i-  impossible  to  chari^e  ;:ie  \r,v> 

In  other  cases  tinned    mi;i\    is   iic-:-ab  e,  Sw:--    n 
a  special    reputation    for  t  he  infant  '•-  fe>  ••; '  n-'-bo:  • .,  .       [• 


(.ts  MAM  A  I.    OF    1HKTKT1CS. 

peculiarly  wholesome  from  the  heritage  \vliich  forms  I  In-  dietary  of 
Swiss  cows.  Tinned  milk  usually  contains  sonic  added  sujjsir,  and 
consequently  onlv  requires  a  certain  dilution  with  water  (about  one 
third)  to  simulate  human  milk  verv  closclv. 

This  leads  us  toasuliject  which  has  been  threshed  out  au'ain  and 
apiin.  The  curd  of  human  milk  is  lighter  and  softer  than  that  of 
cows'  milk.  The  milk  of  various  animals  is  used  as  a  substitute  for 
human  milk.  (According  to  Dr.  Thomas  Do  Ian.  con.-iderable  dill'er- 
enccs.  sutlicient  to  trive  the  subject  a  practical  value,  occur  in  the 
milk  of  dill'erent  women).  On  this  matter  Dr.  I'avv  savs  -"The 
milk  of  the  cow.  accord  ills'  to  above  analvsis.  (I'aven's)  the  most 
closely  approximates  to  that  of  women,  but  it  is  rather  more  hi^hiv 
charged  with  each  kind  of  solid  constituent.  Next  follows  the  milk 
of  the  iroat,  which,  taken  altogether,  is  auain  rather  richer.  That 
of  the  sheep  is  characterized  by  its  marked  richness  in  nitrogenous 
matter,  and  butter.  The  milk  of  the  ass  and  mare  present  striking 
differences  from  the  rest.  The  peculiarity  consists  of  the  small 
amounts  of  nitrogenous  matter  and  butter,  and  the  larp1  amount-  of 
laetine  or  suirar. " 

There  are  variations  in  the  composition  of  the  milk  in  dilferent 
females  of  the  same  species  of  animal,  just  as  there  are  in  dill'er- 
ent women;  hence  the  variations  in  the  analvses  and  estimates  made 
by  ditTerent  authorities.  The  milk  of  the  Aldcniey  co\v  is  the  rich- 
est of  all  cow's  milk:  and  1'lleretier  found  the  milk  of  a  lintiiflli* 
richer  that  that  of  a  1>l<nitl''. — a  conclusion  borne  out  by  the  further 
observations  of  Dr.  Dolan  of  Halifax.  while  Dr.  Hill  llassall  found 
that  the  morning  milk  of  a  cow  is  not  so  rich  in  cream  and  casein 
as  is  that  vjiven  in  the  evening.  Looking  :tt  t  he  analvses  of  milk. 
it  would  seem  tfiat  a  small  addition  of  water  to  cow's  milk,  brings  it 
down  to  human  milk:  while  some  contend  fora  small  addition  of 
suirar.  Nor  need  necessarilv  the  su^ar  be  eaiie  su^ar:  a  little  mal- 
tose siiLrar  is  easily  procurable,  a-  in  Mellin's  food,  for  instance. 
The  advantage  of  maltose  sii'_rar.  in  whatever  form,  to  the  milk  is 
that  maltose  su^ai'  rather  undergoes  lactic  acid  fermentation,  while 
earn-  siiLi'ar  under',:""1'-;  acetous  fermentation  and  acetic  acid  is  far 
more  irritant  than  lactic  acid,  whether  free  or  in  combination  with 
a  base. 

For  some   months  milk  is  all  a  child  requires:    and.  if    it  can  ^et 
a   siifliciencv  of   milk,   nothing   else    is   desirable.       i'.tit    amongst    the 
poor  the  amount   of   milk  is  apt  to  fail  short  of   the  infant's   needs 
and  then  some  substitute  must    be    tumid.       I  p  to  a  recent   time  the 


crust  anil  sole  of  the  wheaten  mat'   were   boiled    i'ur   -..:i:.-   •  ;i 
the    resultant    product      "  pobbs."    mixed    with    -uni'-    niHg 
compound    was   nut   objectionable:    lint    when  a  i:t :  ie  Mcj'ar  <•;. 
added   to    the    "  pohbs."  then  partial    -tarsation   wa-   tii.-    :v-i>.a-  1 
ha\e  stateil   before.       The  addition  uf  a   !iltie  butler  wa-  a:;    imp! 
ineiit:    but  even  that  did  not   provide  tiie  silt-  I  pho-phate-  and  ch'.o- 
rides)  whieli   are   su   desirable.      Speciallv    prepared    bi-euits    wefe   .  ,f 
much  the  same    fond-character;    till   at    ia.-t  the  subject  attracted  ;:..• 
attention  uf   the  chemist    wlio  started    ;u   prepare   sjiccial    "Infant'- 
Foods;  "    uf    which    ^eneraliv    ;t    niav  lie    >!ated    tiia!     lliev  '.-.^  k     fai. 

This    last    can    scarcely  be   said    uf    "lariated"    foud~.  thai   :-.    f i- 

contain inu'  a  ] import  mn  uf  tin', k.  ( >f  t  he  ininurtaiiee  .if  fat  tu  haliii  ~ 
no  unc  can  entertain  a  dottlit,  after  witnessing  theetTects  uf  ,,'! 
unctions  upun  an  ill-nourished  child.  It  niav  Ke  -aid  of  a'nio.-t  a., 
the  [tivptired  Infant-'  I-'oods.  thev  are  intended  a<  adihtions  \»  nn,k 
-  -not  as  substitutes,  for  it.  I'ntil  the  teeth  are  cut.  and  in  the  act 
uf  making  their  wav  thr<ni^h  the  inim.  arou.-e  the  saii\arv  L;'iauds 
into  activitv,  the  infant  has  no  means  uf  deai;nu'  \vith  stai'di.  hefure 
it  reaches  the  jiancreat;'  secretion:  anil  raw  unchaiiLred  .-tar.'h  is 
not  acceptable  to  the  infant  stomach.  Numerous  disorders  of  the 
alimentary  canal  can  fairly  be  laid  to  the  charge  of  unchanged  siarch. 

The  length  ol'   time  a  child    is    kept  t.i  the  bn^^t    is    u-ua.iv  nine 
months.      There   inav    be    reasons    for   weaninir   the    infant    earlier; 
there    niav   be    reasons   (in    the    maternal    mind)    for   euntinu;i!ur    '" 
suckle   it.      But    considerably  before    this    time   is   reached   a    certa.n 
amount  of   food  othei-  than    the  mother's  m;!k  is  usually  ^i\cn  to  :;_ 
Panada,  or  m   nnrscrv  lanirtuiire  "  poblis."  is  well  enouirh  in  its  wav. 
but    its    preparation    is  somewhat    ti'ouble.-ome.      The  diiTeri-nt    pre- 
pared  foods  have  been  discussed   before  and  need   not   occupy  u-  [on-- 
here.      Thev  consist  of  admixtures  of  bake.!  jloiir  and  ma. ted,  \,<-   <.  a- 
rations  as  a  rule:    some  containing  dr;ed    ini.i\  (aiidin^'  tall  .-"me   a 
certain  proportion  of  ground   legume-  (^ivin^  nit  ru^eii ).      \\  !;;.  o\. 
should    be   preferred,  and   the  circumstances   under  wh;>di   o:.e 
wuiiid  seem  n,u!-e  suitable  than  another,  mu-t,  ;n  the   pre-. 
uf  our  knowledire,  be  iei't  for  the  private  jU'i^me":  u!  ; 
in  eaeh  case.      Too   lun^  continuance  witti  an\   o;;e  ;.'o; 
pall  on  the    palate.       A  varietv  of    food   is  as  ae.-epiabic   '•• 

as  to  an  adult —-that  is  of  "  artificial  "  ;' :.       11-   , 

matter    t  horou^hl  v    entertained    in    the    work    of    m\ 
Mustai-e  Smith,  on  "The  I  )i-ease.-  of  I  'hiLiren." 

There    is   one   drawback    to    Hi'1-''    prepared 


MANUAL    OK    niKTKTICS. 

mastication,  and  but  little  digestion,  which  may  as  well  he  considered 
here  as  at  auv  other  point  -though  not  coining  into  operation  till  a 
later  period.  It  i-  a  d  iv.Tession.  Imt  one  of  such  practical  importance 
that  it  niav  he  as  well  entertained  now  instead  of  hein^r  postponed. 
It  is  the  relation  of  rooked  and  prepared  foods  to  the  development 
of  the  teeth,  and  the  prevalence  of  dental  caries.  The  jaw  is  im- 
perfect! v  developed  and  the  teeth  are  crowded.  A  small  mouth  and 
a  liirht,  pointed  chin  art.'  now  our  ideals  of  beauty.  "Muckle- 
mouthcd  Me<j;  Murrav"  the  ancestress  of  Sir  Walter  Scott,  would 
iind  her  chances  less  now  even  than  thev  were  when  Scott  of  Harden 
aliuo.-t  preferred  death  to  marrvin^  her.  There  is.  too.  ;m  imper- 
fect development  of  the  teeth;  to  all  appearance  thev  are  <|into 
riirht,  but  their  dentine  is  of  inferior  qualitv.  and  when  caries  sets 
in.  this  inferior  dentine  is  readily  eaten  up  by  the  tiny  organisms 
whi'-h  arc  at  work  in  dental  caries.  A  biirvvr  jaw  and  teeth  of 
superior  structural  (jualitv  would  be  an  advantage.  The  causes  in 
operation  in  t  his  imperfect  development  of  t  he  mast  ieatorv  appara- 
tus is  now  attributed  to  a  combination  of  two  casual  fa1 -tors. 

1.  The  fact  that  all  food  is  now  so  prepared  that  there  is  little? 
need  of  that  labour  of  the  jaws  which  was  involved  in  cat  hit:'  a  piece 
of  hard  crust,  whether  bread  or  cheese.  There  is,  in  fart,  compara- 
tive disuse  of  the  ma-M  icatorv  orpins  niid  that  is  leading,  bv  an  in- 
evitable law  to  degradation  of  the  organs:  the  jaw  is  ill-developed, 
and  t  he  tect  h  of  inferior  <ptalit  v. 

'.'.  The  furthi'r  fact  is  the  higher  education  of  the  vouiiLf.  A 
child  is  taken  earlv  and  tTaincd  as  hi^hlv  a-  its  powers  will  permit. 
The  brain  and  tin1  dental  apparatus  alike  jire  b'd  hv  branches  of  tin; 
common  carotid  arterv:  to  encourage  the  l!ow  in  one  branch  is  to 
depletr  another:  when  the  blood -current  is  tlowin^  free  I  v  to  the 
brain  its  llow  is  diverted  from  other  branches.  |)i~use  of  the  jaws 
starves  the  areas  supplied  by  the  ma\ii!ar\  arteries;  and  then  when 
the  demand  of  education  comes  these  arteries  seem  specially  to  feel 
this  depletion  bv  derivation  to  the  encephalic  vessels.  The  brain 
is  fed  at  th|-  expense  of  the  maxillarv  area,  in  fa^i. 

The  lack  of  mast ic;i tor \  1'il'orts  is  t  !  •     I  irl  :  LT  'point  of  tin-  morbid 

depart  lire.        'I'll  is         ;i    matte!1    liol    t'»  he  ovel    ookei]    in    the     ft-ei  i  in"-    of 

[ 

children,  and  a  hard  crust  (which  is  highly  digestible)  is  a  v;ood 
t  hinir  for  a  child-  wh^n  it  has  pit  tip'  teet  h  with  \\  hii'h  to  chew  or 
jrnaw  it. 

\\'hen  a  child  is  weaned  it   has  panada  and   milk  (oroii^ht  to  have 

this  last)  in  lib<Ta!  ipiantities.       Nd\\    :t   'j-d-  miik,  when  this  is  feasi- 


hie,  uith  more  or  less  of  tin-  mvriads  of  prepared  f<">d-  . 

ket :    and  if   it  is  in  danirer  of   lieim_r  nndiTl'i'd    in    i r  h»i;- 

I'll  us  an  ftjiial  risk   of   heinir  "\erfed  in  t  he  mir-i'ri''- of  ii,. 

For  a  considerable  time   the   infant  is  so  fed.  until 

to  wield  a  spoon  on  Us  o\vn  ai-<  •<  >n  nt  and  -ha  re  1  lit-  i i<  >ri" • , 

or  Imiiiiny — of   its   older    brothers   and    >i.-ters.      Oatmeal    p"i 

the  staple    breakfast    fond    of   'the    N'urth    of    Kn^iaiid    a:,'  :. 

In  the   more   Southern   areas,  bread    hobcd    in    m'd\   lak--- 

The  dietary  of  the  American  Continent  i-  ri>di  to  a  derive  in  fa;-': 

ceous  (trrjianttions  suiialue  for  the  nurserv  lireakf;i>i-ialile. 

Then    for   dinner   c-onies    the    milk-inhldin^.    preeedeil    \<\    in.-it- 

hrotli.  thickened    with  some  farina us  matters,  which  should  ha'.e 

maiie  the  acquaintance  of  the  tire  hefore  hciiiLT  added  to  the  inea;- 
infusion:  01-  [icrhaps  hv  some  potato"  tineU  liroken  up  \\.tii  -nine 
ijravv  or  meat-juice.  Too  much  of  this  latti'r  is  apt  to  pro'iiiee 
1latu!ence.  colic,  and  diarrluea.  Ktirthennore.  \\dn-n  there  i-\>i 
jiny  looseness  of  the  howt-ls.  this  will  scarcely  lie  controlled  i>v  niedi- 
<Miiai  measui'es.  so  I  on  u"  as  meat-infusions  form  a  part  of  the  dietarv. 
Neglect  of  this  fact,  too  little  known,  has  had  its  etl'eet  upon  infant, 
mortality.  On  the  contrary,  when  the  child  i-  con>tipated.  ,;  may 
he  well  to  !_dvc  some  meat  -infusion ;  as  well  as  the  liu',  prune,  or 
manna,  common! v  u'i veil. 

Too  much  food  brings  ahout  mal-:is~imilation.  jn-i  a~  miiidi  as 
defieieliev  of  food.  "  Amon^  i  he  wealthier  classes,  imperfect  nntr- 
ti"ii  most  (jeiiemllv  arises  IVom  exec.--  in  oiiantilv.  or  a  too  >t;mu 
lat  im.:  'jiialit  v  of  food:  hut  am<>nirtlie  lowei' classes  from  delic:en,-v 
in  (jiiantitv  or  (jiialitv.  addc<l  to  scantiness  of  clothinir.  \\ani  of 
cleanliness  ami  im  perfect  vent  da t  ion.  "  (Comhe. ) 

In    his   treatise  on    "Scrofula   and  Consumption"—  the    'ate   : 
James    (lark    pointed    out    1'oiviMv,    how    imperfect    nutrition 
mismanagement    of  diet    in    early  days,  lay  at    the  root,  or  \vr\   i  <-. 
it.  of   that  imperfect   tissue-nutrition  which,  as  we  .-hall  see  later  n-i. 
is  the  essential  condition  of  the.-e  morbid  states. 

The  milk-pudding   in   the  nurserv  used    t<>   precede   meat  in  ar.\ 
form:    and    this   matter   hecomes    of    more    importance   as 

he^in s  to  eat  meat.      The  starchy  matter-  of  the  t' i.  \\  h;.-li  i 

vSilivarv  digestion  in  the  mouth,  the   gullet  and    the  - 

it  hecomes  acid),  ou-'ht.  on  scientific  and    phy.-:o|o-'i  :  • 

precede    those    matters    \\'hich    arc    digested    in    ; 

nur-i'i'v    rule   would    lie   a    --ond    one    for    invalid-   and 

larger    ^"I'owth.       Such    milk-puddini:.-    arc    madi 


1"L'  MAM'AL   OK    DIKTKTK'S. 

hominy,  semolma.  vermicelli,  shredded  mai/.e,  samp,  SULT<~>.  tapi- 
oca, rice  and  bread  and  butter,  as  their  ordmarv  cons!  n  units.  For 
delicate  children  tlicsr  ditVerent  farinaceous  materials  need  some 
predication  hv  heat.  I>ut  for  healthy  children  it  perhaps  is  enon<rh 
to  educate  them  to  take  then-  food  slowlv.  so  as  to  bnnir  the  starch 
into  Millicieiitlv  lonir  contact  with  the  saiivarv  diastase  to  ensure  its 
conversion  into  soluhle  matter.  In  avoiding  Scvlla  let  us  not,  run 
upon  ( 'harvl >di>. 

'I'he  dietarv  of  the  nurserv  is  ample  in  quantitv  if  restricted  in 
materials,  and  this  is  ^uod.  The  appetite  of  healt  hy  VOIHILT  crea- 
tures rarelv  needs  stimulation,  or  temptation  b\-  varietv  bevond  what, 
has  lieeii  pointed  out  above.  1'iaiti.  wholesome  food  is  piod  for 
children.  "  'I'he  same  kind  of  food  ou^ht  to  he  continued  till  after 
the  appearance  of  the  canine,  or  do^-teeth.  When  these  have  fairly 
protruded,  a  portion  of  soft-boiled  e^  mav  be  ^iven  as  an  introduc- 
tion to  the  use  of  a  mure  completely  animal  diet.  In  Lfcneral.  solid 
animal  food  on ^1  it  not  to  be  allowed  in  any  quantity  till  all  the  teeth 
have  appeared  and  t  he  digest  ive  powers  be  fullv  adequate  to  assimila- 
tion." (('niiibe.)  This  authoritv  holds  the  opinion  that  to<i  much 
animal  fond  leads  to  (1)  imperfect  t  issue-nutrition,  and  delicacy  of 
constitution  mi  the  one  hand:  and  ('.')  to  mental  irritability  and 
peevishness  of  disposition  on  the  other:  and  that  this  combination 
impairs  the  resisting  power  of  the  organism.  (1onse(|uentlv,  such 
improper! v  fed  children  present  lessened  resistance,  both  in  catch- 
ing and  succumbiiiLT  I"  the  ordinarv  maladies  of  children,  as  the  ex- 
anthemata. whoopin^-couLrh.  etc.  The  stronger  the  food,  tin? 
stronger  the  child,  is  erroneous  I'ea.-onin^:  and  strong  meat  is  not 
o-(,,,,l  foi-  babes.  Milk  and  farinaceous  foods  are  the  foods  of  the 
nurserv,  /•"/'  i-.n-i  Ui'iiri . 

As  to  wines  and  alcoholic  drinks,  thev  have  no  business  in  the 
nurserv  under  any  circumstances,  \\lien  a  child  is  so  ill  as  to  re- 
quire such  stimulants,  it  is  well  to  lake  it  out  of  the  nurserv  to  a 
room  of  us  o\\u  for  i  he  time.  To  ^ive  an  ill-nourished  child  M'ine. 
is  an  act  of  weakness  in  mtcl  i^fenee  or  morals.  If  LT'IVCII  to  please 

a  foolish  mother,  it  is  a  sin  a  crime.  |f  I aiise  the  medical  man 

does  not  know  better,  then  it  i--  hi^h  time  that  he  be  referred  hack 
to  his  smdie<  there  is  some  lee-wav  to  be  pulled  Up  ill  his  case. 

<  >f  far  mure  im portancc  is  it  to  insist  u pon  a  sutlicieiicv  of  exercise. 
The  n ven i  mi  of  'i  i-  perambulator  i  ot  been  an  unai loved  ;j'ooil 
for  our  i  tl  e  folks;  ;i  ma\'  be  a  r«-adv  mean-  of  v.vttiiiir  fre-li  air. 
but  rid  ;i  ;  eramhuiator  i-  not  "  exercise.'  The  waxing  limbs 


\v;int  unrestricted  iiioveineii!    for  their  development.      A',<n8 
short  df  faii^ue  >hou;d  In-  lakni  e\erv  'lav. 

Fat  is  essential  to  liealtliv  tissue;   and   lio\v  is  fat    in  !n-  \-. :••,•'.• 
into  t  lie  juvenile  organism  ? 

Tins  is  a  verv  important  mailer  at  the  present  iiav.  and  "!,<•  of 
p'owni";  nnportanee.  I  was  once  illiberal  enough  to  ho'.d  tiiat  ;;.•• 
present  distaste  for  fat  in  the  nursery  was  nothing  more  than  wa:.t 
of  tinnness  on  the  part  of  nurse,  and  mother:  hut  thai  po-:;;i>n  ha-- 
had  to  lie  abandoned.  There  is  a  waxing  inaliilitv  to  t-a!  fat.  Fa', 
in  a  visible,  tangible  form,  is  simplv  repul.-ive  to  manv  chiidivn, 
and  as  such  is  loat  lied.  It  niii.-t  he  "  snr.'.^led  "  into  t  hem.  a-  old 
matrons  put  it.  The  hunch  of  lnvad  with  a  stout  laver  of  hu;t"r 
over  the  upper  surfaet  —  nurserv  lnvad  and  hutter  for  main  chil- 
dren is  utteriv  unsuitable.  The  bread  and  butter  should  be  cut 
thin,  and  the  butler  spread  liLrhtiv  over  the  snrfaee  ("eompanv" 
bread  and  butter),  and  then  this  should  In-  doubled  upon  itsed': 
sueli  is  {lie  rational  bread  and  butler  for  the  nursen  with  ilelieate 
children.  Then  a  ^-ood  piece  of  luitter  should  be  added  t"  eaeli 
"lielp"  of  milk-puddiiiL;'.  and  so  mixed  therewith  as  to  be  l»>\  to 
the  eve.  Uai'on-fat  is  especial  1  v  in  demand  in  the  nurserv.  The  ; ;.pi ;d 
fat  is  most  di"v>tibie.  and  easily  tolerateil  bv  the  juvenile  r-toinaeli 
Ureail  erumhs  mav  lie  mixed  with  it.  or  some  tlourv  potatoe.  The 
latter  with  some  liaeon-fat  and  a  li^ht -boiled  e--^  poureil  over  it  i<  a 
verv  pleasant  form  of  fond.  Then  the  more  solid  fat  of  the  baeon  is 
also  ivadilv  taken  b\-  most  children;  and  a  bit  of  "  papa's  baton  "  at 
breakfast  is  a  wcleoinu  treat  to  mo-t  voun^sters.  Hominy  fried  \\  th 
fat  pork  is  a  form  of  food  in  favour  in  the  I'nited  State--.  The  suet 
puddini:'  with  the  suet  tinelv  mineed  is  an  excellent  uiethod  nf  m- 
t  i-odiiein--  fat  into  youthful  stomachs.  If  a  little  treacle  be  mixed 
therewith,  the  pudding  is  ail  the  better  -both  as  to  the  palate,  and 
as  to  its  own  food -value.  Such  puddings  should  be  eaten  \\\\\\  Mi-_;'a 

best  eaten  wuh  butter  and  .-u^ar." 

llo\\'c\er  ii   is  [tract  icall  v  inanaLTcd.  a  siilliciencv  of   fai  -ho:; 
supplied    ill   order   to   luiiid    up   t  horoiiLrh  !\    hei!th\    t:--uc-.       ]\ 
>liould    never  be  spared.       The  father   or    mo|  her  (u  ho  ean  a:' 
\\dio  does   not   ;diii\\-    their  children   a   siltlie  .•::    \    of   Initrc!'. 


I"1  I  MAM'AL    OF    .PIKTKTICS. 

pav  the  snrireon's  bills  of  a  later  dav  for  operations  on  joints,  and 
scrofulous  Clauds;  to  say  nothing  of  bills  for  the  t  reatment  of  maras- 
inus,  tabes  inesentcrica,  hydrocephalus  and  phthisis:  toget  her  wit  h 
the  bills  for  hoard  and  lodging  at  seaside  health  resorts.  There  is, 
sneh  a  tiling  as  '*  penny  wise  and  pound  foolish:  "  and  this  is  a  ease 
;  in  point.  They  niav  not  grudge  the  cost.  but  recoil  from  the  un- 
pleasantness of  insistence  with  their  children  —  hut.  depend  upon  it. 
this  is  infinitely  less  Irving  than  that,  which  ihev  will  endure  when 
disease  has  fastened  upon  their  hapless  oll'sprin^r — when  regret  is 
unavailing.  I'nfort  unately.  too,  it  must  lie  admitted  that  it  is  just 
t  he  children  who  reject  fat  who  most  require  it.  There  is  something 
more  than  mere  fad  or  fancy,  in  the  child's,  rejection  of  a  piece  of 
sweet  fat  on  its  plate,  and  its  readv  acceptance  of  a  spoonful  of  lisliv 
oil.  It  is  impossible,  indeed,  to  insist  too  earnestly  upon  the  supreme 
importance  of  an  abundance  of  fat  in  t  be  food  of  the  nursery.  It 
is  all  very  well  to  talk  of  jams  and  preserves.  They  cannot  take  the 
place  of  butter.  Thev  are  palatable  adjuncts  to  butter;  but  they 
never  can  be  substituted  for  it!  If  a  child  can  be  induced  to  eat 
bread  and  butter  bv  spreading  some  jam  over  it -----iiood  and  well, 
.lam,  pins  bread  and  butter,  is  a  very  different  mutter  from  bread 
and  jam. 

When  a  child  is  old  enough  to  handle  a  knife  and  fork.  i.e..  be- 
tween four  and  live  ordinarily,  it  is  allowed  small  quant  it  ies  of  meat. 
I  »ut  milk  and  puddings  ami  sweets  are  preferred  till  much  later 
vears  hv  healthv  children.  \\hen  children  get  too  much  meat, 
under  the  mistaken  idea  that  this  will  make  them  strong  that  the 
meal  of  the  ox  will  make  the  child  as  st roni:  as  an  < i.\ — as  ^rc:it  a  mis- 
take as  that  of  calf-lvmph  in  vaccination  being  followed  bv  the 
growth  of  horn- — the  end  aimed  at  is  usuallv  defeated.  The  child 
(Iocs  not  grow  strong.  It  is  indeed,  ill-nourished  and  liable  to  all 
kinds  of  trouble,  from  colic  to  boils  and  ecxemu.  In  Yorkshire, 
where  t  he  fat  her  likes  to  see  his  little  son  eat  "a  bit  of  meat,"  it  is 
quite  common  to  lind  gontvskin  affections,  with  the  urine  deposit- 
ing ;i  sediment,  in  children:  a  condition  at  once  relieved  bv  a  suit- 
able dietarv.  ('hildren  who,  from  a  mistaken  view,  are  given  too 
7i inch  meat  and  encouraged  to  eat  it .  and  who  do  not  t  hri  ve  t  hereon, 
are  soiiietitiies  recommended  so  much  \\'ine.  It  is  needless  to  sav 
t  hat  t  he  reined  v  does  not  lie  in  this  direct  ion.  but  in  one  ilia  metrical  Iv 
opposite. 

I'robublv  children  are  allowed  too  little  fruit.  A  liberal  amount 
of  sound  fruit  is  nut  only  good  in  itself  but.  ii  is  a  prettv  certain 


protection,  or  insurance  air-iinst  the  chiMivn  Lror_riuL:  ;h>-!i 
t'niit  -no  matter  what  itsipiaiitv  at  tin1  lir-!  opportunity.  \- 
before,  "  line  of  the  most  pernicious  ha!>;t-  in  whii-h  children  ran  !»• 
indulged,  is  that  of  almost  incessant  eating.  Manv  mot  hri-s  iMieonr- 
aire  it  i'miii  the  facility  with  which,  for  a  time  iheoilVr  of  •  ~..me- 
l  liinir  nice  '  procures  peace.  Kvm  from  infaii'-v.  the  chll*  i-u^lit  to 
In-  Lfraduallv  accustomed  to  cat  onlv  when  hi!ic_rr\.  ai.'l  \\in-u  fo"d 
is  ivallv  reipiireii.  After  two  vi-ars  of  ap1,  an  interval  of  f.uir  hours 
lictweeii  meals  \viil  rarclv  he  more  than  enough;  and  to  ^i\r  b;-euits, 
fruit  or  bread,  in  the  meantime,  is  ju-t  .-ulit  rart  inir  from  thediircs- 
tive  power  of  the  stomadi.  Like  almost  cvcrv  other  or;_ran  of  the 
hodv.  the  stomach  rfijiiires  a  period  of  ivpo.-r  afti-r  tli'-  lahour  of 
digest  ion.  and  acconiiu<jflv,  in  th'1  hfaithv  state.  \\\i~  sensation  of 
appetite  never  return-  till  it.  lias  for  some  time  ln-cii  emptv.  To 
•jive  food  sooiiei1.  therefore,  is  analogous  to  mr.kinLTU  \\'earv  traveller 
walk  on  without  a  halt."  (('om!<e.  )  To  e^-  on,  or  tempi  the 
palate  to  almse  the  stomaeh  hv  otl'i-riiiL;-  slices  of  seeil-cake,  luins.  ;i!nl 
sweets  of  ail  soils,  lietwi.xt  meals,  is  ;i  cruel  kindness.  Old-fashioned 
people,  \vlio  used  plain  words,  used  to  talk  of  a  "  surfeit  "  when  too 
miieh  had  lierii  eaten.  \Vearetoo  polite  nowadavs,  tou.se  siieli  a 
lilunt  u'oi'd:  iuit  tiie  tiling  for  which  it  stands  remains  iinehanired. 
A  sudden  rise  of  temperature,  often  accompanied  l>y  vomiting  and 
pur'jm^.  is  common  with  children  after  some  undue  "  indu!c;enec.'' 
the  euphemistic  modern  siihstitute  for  "surfeit."  I:  is  nothing 
more  than  a  natural  expur^atorv  process,  accompanied  !>v  a  honlire, 
(the  pvi'exia),  to  evt  rid  of  the  surplus  matter. 

"  Children  should  have  four  meals  a  dav:  hut  meat  onlv  at  one, 
oral  most,  two;  the  latter  when  onlv  a  small  portion  ai  once  is  al- 
lowed. When  in  health,  lliev  should  have  no  wine  or  hccr,  e\i-ept 
a-  a  festive  treat;  no  coU'ee,  strong  tea,  or  other  exciting  drink." 
(Chamhers.) 

( >nc  rule  mav  he  1  rusted  : — a  healthy  child  requires  no  tempt  at  ion 
through  it-  I'aiate.  It  is  ipiitc  rcadv  for  it-  meals  when  tin-  run- 
comes.  Nor,  as  a  rule,  do  children  need  anv  ciicoiira^'cmc!;  to 
[icrsist  m  eating.  Thev  will  t:'encrallv  cat  till  lliev  feel  fu.l.  I'm-t 
a  child  for  that  !  Its  plca-urcs  as  yet  are  few,  and  eat  n 
plea-lire.  //"/'  r.ri-i  llr iit'i1.  of  childhood, 

As  ri-Lrards  the  dietary  of  school,  it  is  now  fairly  liberal: 
in  some  schools  i  he  d  let  -table  i-  iniidc  at  t  rad  :  ve  in  in  vrr-e 
to    the    intellectual    dietarv  provided.      Some    mothei-s    ,;,-:- 
iilierai    table  as  a  >•////•   ,jn/i    nun.       \\'here   childn-n    [>ia\  a  iriva!   deal, 


Idtl  MANUAL    OF    OIKTHTH'S. 

food  in  liberal  quantities  is  ventured.  Hut  as  to  the  vexed  question 
of  plentv  of  \vork  and  little  food,  and  little  work  and  mueli  food  — 
in  other  words,  betwixt  the  well-fed  dunces  of  rich  parentage  ;nid 
the  half-starved,  bright  child  of  poor  parentage.  1  am  not  called 
upon  to  decide.  Work,  play,  and  food  in  nice  proportion,  will  he 
lound  to  p'ive  satisfactory  results. 

M.  Met'/,  of  Mattrav.  the  philanthropist,  found  <:ood  food,  and 
even  wine,  necessarv  with  weak-willed  hoys,  to  enahle  them  to  form 
a  resolution  and  stick  to  it.  AVhile  of  old.  bread  and  water  was  the 
dietary  of  refractory  children  until  they  couid  obey  discipline;  and 
was  effective. 

( '(t't'-ri*  jxirihx*.  1  would  always  back  a  u'ood  breaki'aster — from 
a  bov  to  a  u'amc-cockerel.  A  ^ood  meal  to  heir  in  the  dav  is  a  u""od 
foundation  ! 

When  children  are  ill.  they  require  to  be  fed  according-.  A 
child  will  often  abstain  from  fluids  to  an  extent  that  would  be  \erv 
painful  to  an  adult,  without  apparent  inconvenience:  hut  when  ill. 
it  requires  more  tluid.  A  child  is  rarely  indisposed  without  more  or 
less  pvrexia.  and  then  more  tluid  is  necessary.  Sometimes  lluids  are 
pnrposelv  withheld,  on  the  impression  that  they  would  dilute  un- 
dnlv  the  gastric  juice:  this  is  a  gratuitous  cruelty.  No  child  will 
drink  cold  spring  water—unless  when  overheated  by  effort.  In  ill- 
ness, its  thirst  is  the  measure  of  its  needs.  Home-made  lemonade 
is  usnallv  enough  of  meat  and  drink  for  a  child  in  a  febrile  state, 
with  the  addition  of  a  little  milk  and  lime-water  or  selt/.er  water, 
or  the  equivalent  of  the  latter.  AVhen  tinned  milk  is  used,  whether 
to  a  sie]<  child  or  one  in  health,  it  is  well  to  remember  the  rule  laid 
down  before  about  tinned  foods,  vi/.. — that  thev  should  be  used  up 
as  quickly  as  possible  after  heim:  opened.  Tinned  things  readilv 
become  unlit  for  food  after  the  tin  is  once  opened. 

When  a  child  is  convalescent,  nsuallv  its  appetite  is  keen,  and  it 

takes  !' ':  eagerly,  and  even  greedily.  All  sorts  of  milk  puddings. 

rice-milk,  plain  broths  with  baked  flour  or  broken  biscuit,  and  -tewed 
fruit  with  cream,  are  ^ood  and  proper.  At  this  time  a  child  is  very 
liable  to  take  more  than  it  can  properly  digest .  and  acute  indiges- 
tion often  deiavs  convalescence.  Its  u'uardians  are  <jdad  to  see  it  eat, 
and  it  relishes  its  fond.  lint  to  quote  a  plain  nurserv  a  \ioni  some- 
times. "  Its  eves  are  hi^er  than  it  shelly:""  which,  beinir  translated, 
means,  that  it  lake-  in.. re  than  it  can  deal  with.  Then  a  "  surfeit  " 
follows.  Some  cli  Idi'ei  are  ijfrnss  feeders:  -nine  are  daiiitv  feeders. 
These  latter  need  tempting  by  various  viands,  served  up  \\  it h  ,-crupu- 


Ionsclea7ilinc.es.  Little  neat  sandwiche-  made  with  potted  ini-nt-,  •  .:• 
a  thin  slice  from  the  thickest  part  of  a  tongue,  or  of  lioiled 
ami  nicely  arranged  on  a  plate,  will  often  tempt  a  fast  id  ion-  pala 
and  a  halting  appetite.  One  golden  rule  there  is  in  fee.lmi:  an 
invalid  or  sick  person,  child  or  adult,  and  that  is— never  ^ri\e  them 
too  much  on  their  plate  at  once;  this  at  once  impair-  the  />•-;. 
Ilather  it  should  he  on  the  short  side,  so  that  the  inclination  i-  for 
more.  Further,  little  appetising  dishes  are  often  devi-ah'.r. 
"  <  H't  en  a  child  will  eat  a  small  bird,  as  a  lark  or  a  snipe,  when  he 
turns  with  disgust  frmn  beef  and  mutton."  (Kustaec  Smith. )  !:;- 
deed,  with  delicate  children,  their  tastes  must  he  eoiisiitted,  ju-t  as 
in  an  adult.  "(Jrown-up  people  are  permitted  to  ^i\e  their  like- 
and  dislikes  free  plav.  and  judi  -iou-  wives  and  cook-  studv  the  tastes 
of  theii-  lord  and  master,  and  see  that  he  is  dulv  furnished  with  Ins 
favorite  dishes:  hut  the  poor  victim.- of  nursery  abstract  principles, 
are  often  forced  to  consume  things  which  thev  ubhor."  (l-'arou- 
harson,"  School  1 1  v^ieiie. ") 

(Mi  the  other   hand,  there   is   "bulimia:"    which    is   not    nien-lv 
the   u'luttonv  of  .John    Ueed    in    ".lane  Kyre."      "John    liccd    was  a 
sehoolhov  of  fourteen    vears   old.  larire,  and    stout  for    his  ai:'e.  w;:h 
a   dint,ry  and    unwholesome   skin;     thick    lineaments    in   a    spacious 
visage,    lieavv    linilis    atiti     iarire    extremities.        lie    ^or^ed     him-c!f 
lialntiiall v  at  table,  which    made    him    bilious,  and    irave    him   a  dim 
and    bleared   eye   and    ilabby   cheeks."      Such    is   Charlotte    Uroni.-'s 
tvpical    sketch   of   a   juvenile  glutton.      Such   a    bo\-    \\a-   -tutT''d    at 
home  in  a  most  foolish   fashion:    but    no   doubt,  boxes  and    hamper- 
containing;  rich  cakes  and    other    toothsome    comestibles    Wel'e    re^n- 
larlv  sent  to  him  at  school,  till  a  nio-t  unwholesome  product      i<li\-, 
eallv  as  well   as   psvchieall v — was    the    result.      There    i-    "bulimia" 
not   infreijiient  1  v  met  with,  after  some  of   the  maladies  of  childhood. 
and    in    mv   o\vn    experience   (•'•nainlv,  after  measles.      There  \\ould 
seem  to  be  some   low  j  ii  tla  n  1 1  nat  or  v  condition   of   the  miicou-   hn;:  ur 
of   the  alimentarv  canal,  some  sub-miico-enterit  is  ,-et   up.  \v  In- 
tensifies the  normal  senst;  of  liunu'er.      The  child    lie^s  p;teon-',v  : 
fooi!  ilnriiiiT  tlit1  intervals  bet  wi  xt  meal-,  it  -  I'eijne-t   ;-  complie.i  \\ 
with  the  result  that  no  portion  of  the  food  (or  \ery  little)  :-  diL; 
the  i-hdd    remains  practically  unfed:    it-   seii-ation    of   ImiiL:1 
onl\'  not    relieveil,  but    it    waxes  stronger.       In    -iich    case-.  IIP 
amounts  of   food  at  proper  intervals  are  csseiit  ;a!  to  reco\  e 
the    bulimia    mav   be    relieved    by   ,-umu   .-cdativu  — fur    an    >  • 
sensation  is  really  pain. 


10>  MAM'AI,    ()!•'    1>IKTKTK'S. 

Ill  inherited  syphilis,  the  babe  is  not  only  cachectic,  lint  its 
mother  cannot  feed  it  properly,  as  her  own  milk  is  thin  and  \vatrrv. 
ami  comparatively  innutritivc.  Here  Kustace  Smith,  and  others, 
have  found  malted  foods,  after  the  manner  of  Mellin's,  verv  satis- 
factory. 

Then  there  are  chronic  conditions  of  t  issne-de^enerat  ion,  as 
scrofula  and  rickets,  one  of  glands  and  the  other  of  hones,  not  rarelv 
found  together,  which  re(|U]re  their  o\vn  appropriate  food.  lu 
scrofula,  starchy  foods,  even  if  rendered  soluhle.  are  insutlicieiit :  es- 
pecially \vheateii  Hour,  which  has  been  deprived  of  the  bran,  -rich 
in  phosphates.  Here  "meat,  fresh  eiru's  and  vegetables  "  are  desira- 
ahle.  (  Kustace  Smith.)  \\'e  have  seen  hefore,  what  Liehiir  had  to 
sav  ahout  the  larirc  quantities  of  salts,  especially  phospl-.ate  of  soda, 
which  exist  in  vegetables.  Much  the  same  mav  be  said  of  rickets; 
where  phosphorus  for  stouter  bones  is  urgent Iv  demanded;  and 
where  the  svstem  is  unequal  to  breaking  up  the  phosphate  of  lime. 
If  a  laxative  is  indicated,  then  phosphate  of  soda  may  be  j/iven,, 
which  is  not  onlv  a  laxative,  acting,  too,  upon  the  liver,  but  also  a 
true  tissue- food.  Indeed,  if  phosphate  of  soda  took  the  place  of 
castor  oil  in  the  uurserv,  it  would  be  well  for  infant  economies. 

In  the  feeding  of  infants,  a  <rreat  matter  is  to  hit  the  happy 
medium  betwixt  too  much  and  too  little.  The  results  of  over- 
feed  in-  •."  ;ts  of  "under-feeding'''  are  much  the  same;  there  is  im- 
perfect nutrition  in  each  case. 


CTTAPTHTl    XII. 

IX    Yor'l'll    AM)    ADOLF.SCKXCK. 

FOR  our  prseent  purpose  infancy  m;iv  he  taken  to  cease  at  the 
pommencement  of  the  second  dentition:  usuallv  aliout  tin-  eighth 
year. 

\\hentlieniilk   teeth   are  hein::  shed,  and    the   permanent    teeth 

arc  taking  theil1    place,  a   like  change  ",'oes  on   1:1   the  palate,  and    >!!••- 
eulenf  and    sapid  meats  are    more  craved    after.      Not  onlv  that,  hut 
t  liere  is  more  extensive  %irn>\vth  Lifoin0;  on,  reijuiriii":  a  plentcnu-  -upp'.v 
(»!'  lissue-huildinu;  material.      The  change  of  taste  conies  op,  <_yra> : i:a '.', \ . 
and  it  is  not  till   after  pidierty  that  the  full   eravinir    for  the  ;V-i,  , 
animals    is   ordinarilv    developed.       Kin--   Chamliers,    whia 
maintaining    the    need    foi-    plain    wholesome    fond.    -a\-    "  K\;  ivme 
monotony  should  he  avoided."      lie  also  condemns  "  t'auii'.v  u-h:m<' 
ahoiit  food.      '*  It  is  astonishinir."  he  Li'oes  on,  "  ho\\-  in^raiiieil  soim1 
of  tlie>(!  acquired  idiosyncrasies  hceome,  and   indeed  after  full    man- 
hood    IS    reached     tllt'V  may  he  concealed,    lilll    are    never    (jUlie    o\. 

come.      Yet  fe\v  of  the  minor  thorn-  in  the  roselmd  are  so  ve\ai  "••< 
to  one-elf  and   others.      I   shall    not   sonn    forget    the   annovanee  (<:' 
taking  a  VOIUIL;'  man   to  a   (iivemvich   dinner,  and    iindinu"   that    he 
never  ate  anything  \vhieh  .-\varn  in  the  \vater-."      It  i~  clear,  nuieed. 
that   he  wished   that  that   voting    man    was    ea~t   upon  a  de.-ert   :-!and, 
wit  h  only  deni/.ens  of   the  sea  for  eiioiee,  \\hen    he    penned    the 
tence.       I-lveii    adinit'.ii!^   that    the   dietar\    of   the   yoiin^-   -::.-ii'i 
simple,  he  think-  it  a  u'ooii  plan  in  view  of  future  !'-ii -•'].:.-•  i;   | 
world,  if   vomit;;  persons  \\-nnld    learn  local   what   is  ,-et  liefore   ti,.  •, 
—  .-o  tar  a-  t  he\'  a  re  ahle  ! 

Then  comes  the  (piotioii  of  -chool  !.;'.•.       I"  (.'real    I'.r  •  .  M  .•:• 
[ti'e.-ent  dav  no  sidioul    has  ativ  pi'o-pect    «\    ,-i;r\i\al    'A:. 
[irovide  a  liheral    dietary.      Mr.  Npieers    of    I  '-  the-! 
lind  it   verv  diHiciili  to  make    his   selieiiie  work    at    the 
'I' he  institution    of    the  IVnnv  1'o-t    ha-  !>;;;•;••;   the  - 
feeding  at    schools,      at  ha-f    for  \»>\~.      A:.<       :    Uigj   M 
!  f   a  ~e||(  ii  i!  Hi  ;-t  re--  \\-i  mid  -ce  an  v  of    her 
her  , k   kept  a  t  iny  v,  a!  "!': ::^-<-a  ::    \\  / 


110  MAM: AL  OF  JMKTKTICS. 

t he  toast  with  water  t<>  economize  butter.      An  old   Xortli  Country 

vcomaii  used  to  tease  me  when  a  schoolboy  bv  telling  me  "  There 
are  onlv  two  creatures  that  will  j>av  for  starving-  school  children 
and  wintering  sheep."  (In  both  eases  the  pay  was  forthcoming  if 
the  creatures  were  handed  over  alivi — no  matter  in  what  condition.) 
All  t  hat  is  changed  now. 

I  >r.  Fanjuharson  strongly  condemns  (lie  habit  of  eating  confoo- 
tioiierv  and  sweets  betwixt  meals,  which  he  terms  "gastronomic 
nipping;"  in  allusion  to  alcoholic  ''nipping'"  or  drinking  betwixt 
meals.  lie  also  protests  against  the  svstem  of  hampers  from  homo. 
King  Chambers  delivers  himself  thus — ''The  gorging  themselves 
with  past  rv  and  sweet  stulV  at  the  confectioner's,  as  practised  habitu- 
ally by  schoolbovs  and  often  by  girls  when  they  get  the  chance,  lavs 
the  foundation  not  onlv  for  indigestion  in  after  years,  which  is  its, 
least  evil,  hut  also  for  a  habit  of  indulgence  which  isa  curse  through 
life."  It  is  indeed  a  survival  of  the  practice  of  supplementing  the 
scantv  rations  in  the  old  semi-starvation  days,  when  some  such  extra 
food  was  really  required.  lint  at  the  present  day.  it  has  no  valid 
foundation:  some  cheap  sugar  or  sweets  for  the  ill-fed  children  of 
squalid  neighborhoods  is  another  matter. 

I>r.  Farqnharson,  who  was  medical  olVicer  to  liiigby  school,  lias 
had  both  the  opportunity  and  the  inclination  to  study  the  school 
regimen.  He  says  authoritatively — "Little  children,  probably,  do 
not  require  meat  once  a  dav.  but  growing  lads  working  hard  both 
with  brain  and  muscles,  require  a  liberal  allowance  of  nitrogenous 
food,  and  will  hardly  be  satisfied  with  the  old-fashioned  breakfast 
of  tea  and  bread  and  butter.  To  the.-e  must  be  added  something  of 
a  more  nourishing  character,  and  actual  llesh  may  be  frequently 
varied  by  fish,  bacon,  or  eg^s,  which  need  not  be  in  large  quantity, 
but  good  of  its  kind  and  well  prepared."  (Like  King  Chambers  he 
is  dead  against,  a  stilT  lesson  before  breakfast.)  As  to  dinner,  he 
observes.  "  It  is  not  of  coiiivo  an  easy  mat  ter  to  provide  much  variel  y 
under  the  ordinary  circumstances  of  school  life:  but  the  perpetual 
roast  joint  may  sometimes  he  boiled,  or  baked,  or  stowed,  meat  pies 
and  Irish  stews  and  various  hashes  may  lie  given  from  time  to  time; 
and  the  opportunity  should  not  be  neglected  of  proving  how  e;<>od  a 
thing  cold  meat  really  is,  in  spite  of  the  social  obloquv  to  which  it 
has  been  for  so  lonir  subjected.''  At  this  point  it  mav  be  said  that 
the  great  objection  to  stews  and  hashes  lies  in  the  suspicions  of  tin; 
children  and  their  parents,  that  they  are  made  of  inferior  meat. 
As  to  cold  meat,  in  hut  weather  cold  meat  with  potatoes,  (old  ones 


IN    Ynt'Tll    AND    ADoI.KSCKM  K. 

71 1:1  si i dl  and  new  ones  boiled)  and  other  vegetable  ;  >:•»•;:;••'-.  :, 

I'oi'  instance,  or  greens,  forms  an  excellent  nuddav  mea,.  |>..- 

tor  goes  on.    "  We  have  aln-adv  spoken    of    the  great  die-. 

taiye-   of   vegetable  soups  and    Mewed  frui:,   and    of   -!••.•:,    . 

which  keep  up  tin1  balance,  so  important  '"  '"'  maintained.  ;, 

nitrogenous  and  non-nitrogenous  food."    He  hold-  that  a  ;'  n-m  of 

Clplellt     >eur\'V    IS   apt    to   develop     I!)     schools    where    the     Vegetable     eie- 

nient  is  defective  in  tlie  dietarv.  "  The  major  f.irm-  of  lh;~  terrible 
disease  are  rarelv  met  with  nowadays,  but  miniature  tvpes  occur 
much  more  frequently  than  is  generally  supposed:  and.  when  bov-' 
grow  pale  and  ilabbv.  when  thev  readilv  bruise  \\hen  struck,  and 
when  their  gums  an-  spongv  even  to  the  smallest  decree,  then  our 
suspicions  should  be  aroused,  and  \ve  mii.-t  direct  the  treatmiMit  ae. 
cordin^'lv.  and  this  will  not.  be  bv  di-itLrs  a'oiii'.  but  liv  ordering;  the 
consunifition  of  such  things  as  will  sujiply  the  veu'ctabjc  acids  which 
keep  Up  a  healtllV  OjUalitV  of  the  blood."  (School  Hygiene.) 

When  boys  are  but  day  scholars  and  otdy  dine  at  school,  thcv 
share  the  familv  fare;  aud  the  walehi'ui  maternal  eye  sees  that  thev 
L;'et  both  sullicieiicv  and  vai'ietv. 

Tea  is  a  liu'bt  meal,  whatever  its  composition,  and  is  followed  bv 
bread  and  milk,  or  perhaps  brca  1  and,  cheese  and  some  ii^ht  beer 
as  supper. 

"  Then  something  mav  be  said  of  athletic  trainin--.  Absurd  old 
whims  of  the  prix.e-rin^  still  linger  as  traditions.  .Meat  all  but  in- 
nocent of  the  tire  is  preferred  to  cooked  meat,  contrarv  to  ail  phvs.o- 
lo^ical  teaching,  (ireen  vegetables  are  t'orbiddi-u.'1  1'ies.  puddings 
and  sweets  are  eschewed  rigorously:  despite  the  fact  thai  llnnloo 
wrestlers  train  on  sweets,  as  Sir  .lo-eph  l''a\rcr.  M.|).,  \\.(  .S.I. 
informs  me, — "while  strong  iile  or  port  take  the  p. ace  ,,;'  other 

bc\  "erases.  "        "A   ScllOolboV   who   gets    ple!ltV  of    sleep     ill     good   ail'.    IS 

well-fed  and    not  overworked,  .and  plavs  at  iranic-    vigorouslv  aii    the 
year   round,  mav  be   said  to  be  in  a  perpetual    state  of    training,  and 
liardlv  requires   to  adopt   anv  particular  system:    bui    he    ;-   sure  to 
have  picked  up  from  books  or  ignorant,  people  some  fantastic  7!«t  .or;< 
about    diet,  and    these   should    be   dispelled    as   -piickly  a-    po- 
(  Farijiiharson. )      He  admit  ~.  "  It  mav  be  ueee-sary  to  enfoi-c 
diet    rc-'imen   on    professional    athlete-    who    tend    to    lead    ;rre_ 
live-."     In   the  diet-table-  of   boating   men    which    King  ('! 
copie-  from  Maclarcn's  "Training  in  'I  heory  unu  in  1'raci. ••••«:• 
is.  nothing  reiiuirkiible,  lei  alunc  niysteriuiio: 


1  \~2  MANTAI,   OK    DIKTKTICS. 

CAMBKHHiK    SYSTK.M. 

St'MMKR    RACKS. 
A    DAY'S  TKAIM\<;. 

Uiso  at  ?  A.M.          HUH  100  or '-.'00  yards        The  old  system  of  nin- 
Exereise.  as  fast  as  possible.  ninjj;  a  mile  or  so  before 

breakfast  is  fast  p>iii£ 
out.  except  in  the  case 
of  men  who  want  to  u'ct 
a  p>od  deal  of  flesh  olL 

Breakfast     at          Meat,  beef  or  mutton.          Underdone. 
8.:!0.  Toast,    dry.      Tea.     two 

cups;  or  towards  the  end 
of  training,  a  nip  and  a 
half  only.     \Vatereivsses 
ocetisionally. 
Kxnvise  (fore- 
noon). None. 

Dinner    about1         .Meat,  beef  or  mutton.          Some    colleges     have 
:'  P.M.  I'rrad.          Vegetables —      bakeil  apples,  or  jellies, 

]iotatoes.  irreens.       Beer,      or  rice  puddings, 
one      pint.  Dessert 

oranges    or    biscuits     or 
\\'j>.    \\  me-    -t  wo  glasses. 
MxiM'eise.  About    .").:]()   start    for 

1  lie  I'l  ver  .and  row  to  t  lie 
starting    |'osi    and  back. 
Supper  about  Meat .     cold.       Bread. 

S  or  !'.  X'e^'etables      lettuce     or 

watel'eresses.      Beer,  one 
hint. 


\v 

A  Day's  Training. — The  only  ditlVrenee  is  a 
meat  at  one  P.M..  "  with  half  a  pint  of  beer,  or  bisniit  with  a  irlass 
of  sherrv.  perhaps  a  voik  of  an  CLTL:  m  I  lie  sherrv  " — instead  of  sup- 
per;  and  the  rowing  exercise  at  two  P.M.,  instead  of  half-pa.-t  live. 


The  dietary  ist!i:it  of  a  well-fed  prudent    na\vv.  \vho    . 
self  so  a-   to   earn  tin.-  best    wap'S    he  can.--  -xvh:!'1   '!!•• 
far  ,-hort  of   his  work:    then-  heln;_r  thi-   dilYeri-i.cr.  the  i;,-i      •.   -,\.,. 
hard  aii'l  steadily  for  maiiv  hours,  while  a  raciii'j;  '-r<  \'.    ha1,'-  N>  u..: 
a  supreme  ctl'ort    fora  liiuitetl  time.    eerta;nl\    under   »'..<•  i     ur.      A 
highly  nitro^-eiiised  ilietarv.  a-  we  have  ~een    In-fore  aUi-w!    tu^SBfi  I 
essential  to  ilie   rapid    liberation   of   force  —  the   oarnivorou-    panther 
can  pounce  upon  t  lie  deer,  which  would  soon  leave  the  pat  it  he;-  |  ),,.„.. 
lesslv  behind  in  a  fair  race. 

I'lirsuinv;  the  subject  (with  hcalthv  voutrj'  person-:  under  con- 
sideration at  present),  soinetliin^  mav  be  said  of  the  reiriui'-n  •>!' 
,Lrir!s.  The  i-e^iiiieii  of  ifii'is  is  plain1'!1  than  that  of  liovs.  llvi-ou's 
"  bread-'ind-hut  ter  misses"  remain  niU''h  the  same.  Kleo-ance  in- 
volved fraLrilii  v:  and  foi-  a  boarditi^-sidiool  ^irl  to  look  robust  ;(nd 
a  p  pie-cheeked  was  to  call  forth  the  deri.-ion  (if  her  sd  .....  i  mat  >•-.  with 
t  lie  crude-  sat  ire  of  the  younu'  and,  allusions  to  "  dairvmaids.  "  After 
speakinir  <>f  the  evils  of  overfeed  1  1  IL:'  ati'  i  the  mal-a>-imiiat  ion  -o  in- 
duced. (  'oml  ie  wi-oti  —  •'  The  op  posit  i-  error  of  not  pi'o\  idinu'  a  -;i:!i- 
eieiiev  of  noui'ishinir  diet  for  the  voting  is.  from  mi-taken  views. 
much  more  pi-evaient  than  it  ouLfht  to  be.  particular!  v  in  female 
lioardiiiLT-si'liools.  where  th<'  >vstem  of  diet  is  often  msullie;.-:;t  :',ir 
due  stistenutiec  and  ^1'owth:  and  where  eoiiseijuent  lv  the  natural 
expression  of  impaired  health,  if  m>t  actual  disease,  ;-  a  marked 
feature  in  the  jispcct  of  mo-t  of  the  pupils.  So  defective  indeed  ;- 
the  common  school  management  in  tin-,  and  other  respects,  that  \\'e 
have  the  best  authority  I'"!1  eonsiderim:'  it  as  a  rare  exception  for  a 
p'irl  to  i-etiirn  home  in  fui!  health  after  speiidinLf  two  or  three  years 
at  an  Knirlisli  hourtliiiir-sclionl.  h  is  ti'tie  much  of  this  i'e-iii; 
owin^LT  to  eotiiiiiement  .  iiciflect  of  cheerful  exercise,  i  ,  i-\  en;  :  .;;;  "d 


that  of  an  insutlii-ietit  dietarv  must  often  be  a'iiled.  and  \\  heii  . 
exist  it  aets  with    double    force  from    the    impaired    di^'e.-t  ;on.  \',II'.CM 
seldom  fails    to   ensue    where  the  laws   of    health    arc    -o    v 
raired.  " 

I  >!'.    I'.ai'low    on    '•  Physical     Kdtieation"    in    the    "hie! 
I'ract  jcal   Medicine  "  think-  that  of   error-  of    die;  a  -pare  ;-,•_ 
more  deleterious  on  the  whole  than  a  nutrition-;  one. 
of  casual  repletion  are  less  prejudicial  and  more  ea-i!\ 
those    of    inanition."     To   an    imm-rfec!    d:eiar\    ; 
digestive  power  from  visceral  eonuv-;  :on  and  :nact.\  ' 
due.   part!v,  to  lack  of  outdoor  exeivi-e.  partly  to  .•,•'!!:> 


1  1  1  MAM'AL    OK    DIKTKTK'S. 

viscera  in  order  to  secure  a  graceful  figure.  To  appearance,  inaiiv 
sacrifices  are  made  l>y  girls.  In  order  to  acquire  pallor  and  get  rid 
of  tin-  hue  of  health  some  girls  take  an  excess  of  vinegar,  and  attain 
their  end  by  dest roving  their  digestion.  Others  attain  in  order  to 
acquire  the  desired  hue  eat,  r:i\v  rice,  until  by  setting  up  confirmed 
constipation  tliev  ruin  t  heir  sanguiferous  niacliinerv.  It  is  difficult 
for  a  schoolmistress  to  \vateh  and  detect  the  vagaries  of  her  charges, 
no  doulit.  or  discover  the  amount  of  slate  peii'-il.  chalk,  etc.,  de- 
voured in  secrecy;  and  with  this  aspect  of  the  subject  \veare  not  at 
present  concerned.  Then  the  dietary  of  school  girls  is  loss  highly 
nit rou'enised  than  is  that  of  boys;  and  this  is  desirable  so  IOIILT  as  the 
physical  exercise  is  so  limited  as  it  at  present  is. 

Breakfast  usually  consists  of  bread  and  milk  boiled,  or  porridge 
followed  by  toast  dry,  or  buttered,  Avith  rashers  of  bacon  or  meat  in 
some  form.  Then  at  midday  dinner  there  is  meat  Avith  vegetables 
and  milk  puddings  of  all  kinds  and  varieties-— excellent  food,  as  Dr. 
Beaumont  found  with  Alexis  St.  .Martin. — with  stewed  fruit.  A 
suflicienev  of  this  latter  is  desirable  where  there  lurks  a  tendency 
to  constipation.  Tea  is  a  light  meal,  and  supper  consists  of  bread 
and  milk.  The  dietary  is  apt  to  be  deficient  in  fat,  and  butter 
should  bo  freely  used.  Cod  liver  oil  is  often  requisite  where  the 
assimilation  of  fat  is  defective,  or  the  palate  abhors  it.  So  much 
for  schoolgirls. 

The  broad  rules  of  the  dietary  for  an  active  outdoor  existence 
indeed  are  followed  in  a  vague  Avay.  With  more  physical  exercise 
would  come  a  taste  as  well  as  a  demand  for  more  meat  in  the  dietary. 
So  lon;_r.  however,  as  the  exercise  taken  is  restricted,  so  long  it  is 
well  to  have  a  dietary  arranged  accordingly  therewith. 

And  in  connection  Avith  this  subject  of  feeding  young  people, 
two  matters  may  be  considered  of  much  importance  in  early  life. 

Of  all  the  food  taken  into  the  animal  body,  carbo-hydrates,  al- 
buminoids and  fats,  each  ami  all  can  he  found  in  the  vegetable  world. 
Pnlv  metabolism  and  oxidation  —  the  one  for  tissuc-buildinir.  the 
other  for  the  production  of  heat  and  force — LTO  on  m  the  animal 
world.  The  plant  builds  up.  giving  olf  oxygen:  the  animal  oxidises. 
The  plant  has  no  temperature,  it  is  alleged  (but  where  molecular 
activity  is  going  on  there  must  be  production  of  heat  ).*  while  ani- 
mals vary:  the  lower  possessing  some  heat  while  the  higher  animals 


have  a  distinct  body  temperature   of  some  inn     l-'ahr..  derived  frmn 
combustion    \vithin    tin-    organism.       The    plant    i-    mot  joui.  •-  .;    ;!,.- 
warm-blooded  animal  is  active.      These  t  wo  matters     lm.lv  ina-  a:, 
mot  i lit  v.  U-loii<j  t<>  t  he  animal  world.      ( 'i»nsc(|iie]it  Iv  die  an: ma 
sesscs  for  these  ends  a  circulation  and  a  ner\ous  system. 

Carbon  and  hydrogen  unite  \vitli  oxygen,  hut  the  blood  imiM 
contain  an  oxygen  carrier  for  this  combustion.  Tin-  rvd  blo'.d- 
corpuscles  hear  the  carbonic  add  to  the  lun^s  <_rivin:_r  it  oil'  there; 
and  take  in  oxvp'ii.  The  venous  blood  laden  with  carbonic  acid  ;- 
dark  in  hue.  The  arterial  blood  charged  withoxviren  is  bright  in 
hue.  \\  hat  is  it  which  curries  on  tins  chemical  interchange  I'  Ii  ; 
the  luvnuurlobin  of  the  red  blood  corpuscle.  I  hemoglobin 
a  very  complex  substance  with  a  formula  scptnethin^-  like  this 
( '  ,  1 1.  X ,,.( >.,So  ,!•"<),.,  witli  o  or  4  percent,  of  water  of  crvstalli/ation. 
This  compk-x  body  has  to  be  built  up  within  the  animal  econoniv, 
Ix'inir  essentiallv  an  animal  substance.  The  plant  has  no  require- 
ment fora  blood-corpuscle.  Its  eirculatiii'jf  thud  corresponds  to  the 
liquor  saiiLruinis.  Consefjiiently  luemoirlobin  cannot  lie  taken  from 
without.  Nor  can  it  be  introduced  into  the  svstem  bv  il'MiikniLj 
l)lood.  It  consists  of  a  union  of  luematin  (('  II  ,\  !•'<»  I  with  a 
proteid,  and  that  proteid  must  bu  cunverted  into  a  peptone  ere  ;t 
can  ]>ass  into  the  blood. 

Amemia  is  a  dearth  of  red  blood-corpuscles,  which  H  not  curable 
merely  by  furnishing  iron   to   the  system:    though   of  course,  iron  i- 

part  of   the  cure.      At  pubertv.  es| iallv  in  ^ii'ls.  there  is  a  di>tin>-; 

tendencv  to  anremia.  Sometimes  there  is  even  chlorosis  or  LTreen 
sicklies^,  with  a  positive  breaking'  down  of  the  blood-corpusc]c<.  and 
discoloration  of  the  skin  from  lirt'inoirlobin:  ju-t  as  a  bruise  change- 
its  hue  to  p-reeii.  as  the  elVused  hlood  is  absorbed.  Kor  the  cure  of 

aiuemia — and   also    for   its    prevention — j/ood    f I.  containing  a  fa  :• 

amount  of  meat,  and  fresh  air.  is  as  essential  a-  iron  itself. 

So   much    then,  foi1   one   maladv    linked    with    the    later    veai< 
growth,  whii'h  rcfjuires  its  dietetie  as  much  as  its  medicinal  mana'je- 

Animals  possess  a  nervous  svstem:    also  a  matter  not   ivoir.red  bv 
the  vegetable   world.      This  nervoii-  system  has    its   own    want-.  ; 
it-    food    seems  a    phosphorixed    fat.  known    as    "  Lee,:  hut." 
formula  ('.,11  ^M'* )  .      It,   too,  i-  a   eompl 
t  he  or^ani>m.      When  the  brain  i<  o\crworked   fora  lon-j1 
fii  ml  ion  a  1  act  ivit  v  i-  impaired,  as  seen  in  "  o\  cr^t  ii'i  v. "       V    a  n-M 
of  fact,  however,  the  voiui1.;'  man  \\lio  ha- 


1  1'"'  MANTAL    OF    DIKTKTICS. 

;i  person  with  a  ii;itur;illy  feeble  brain,  which  lias  been  found  un- 
equal to  surmount  ini;  the  usual  educational  tests.  Recent  Iv,  when 
compulsory  education  has  caught  in  its  net  all  our  wails  and  strays, 
or  social  Ara!>>.  it  has  lieen  found,  as  a  matter  of  fact,  that  "  over- 
studv."  leading  to  lira  in  collapse,  is  quite  coiunion.  \\  hen  the  poor 
little  tilings  can  p't  enough  to  eat  and  feeil  their  brains,  then  these 
last  arc  quite  equal  to  what  is  deinandeil  of  them.  \\  hen  the  dietary 
of  girls' schools  wa<  notoriously  insuilieient,  a  break-down  was  far 
from  an  infrequent  event.  Rest  from  work,  change,  and  a  more 
liberal  table,  brought  matters  ri^ht  in  time. 

\\  e  may  suppose  a  failure  in  the  supply  of  lecithin  as  the 
material  factor  of  this  brain  exhaustion.  As  phosphorus  is  a  con- 
stituent of  lecithin,  this  element  should  be  supplied  in  any  form 
\vhichcaii  furni.-h  it.*  Our  assimilat  ive  processes  seem  ordinarily 
to  possess  the  power  to  break  up  phosphate  of  lime,  or  phosphate 
of  snda.  and  so  provide  the  free  phosphorus  required  for  the  nutri- 
tion of  the  nervous  system.  P>ut  under  the  unfavorable  circum- 
stances of  under-nut rit ion.  the  power  seems  to  be  more  or  les-  com- 
pletely lost,  and  then  it  becomes  necessary  to  furnish  phosphorus  in 
forms  less  stable  and  more  easily  broken  up.  'The  hypopliosphites 
arc  available  for  this  end:  and  may  advantageously  be  added  to  the 
dietary  when  the  demand  upon  the  brain  is  i^reat  and  the  assimila- 
tive  powers  arc  feeble,  or  food  is  supplied  to  them  in  insuilirient 
quant  it  v. 

Iron   then,  for  ana-mia.  phosphorus  for   brain   exhaustion:  —  -but 

hot  !l    wit  ll    a   Sllfliclency   of    food. 

Indeed,  in  youth  and  growth,  the  maladies  are  mostly  (except 
the  contagious  diseases  and  the  results  of  exposure  to  cold)  the  out- 
come of  insufficient  nutrition.  As  was  pointed  out  before,  the 
consequences  of  over-feeding  are  much  t  he  same  as  those  of  under- 
feeding: because,  in  each  case  it  is  a  question  of  defective  a^simila- 
t;ou.  T'i  swallow  food — and  to  digest  it,  are  not  one  and  the  same. 
It  is  what  i-  digested.  —  not  merely  what  is  eaten — which  has  to  do 
with  nut  rit  ion. 

The  appetite  of  youth  needs  not  the  stimulus  of  food  tempt ini: 
to  the  palate.  Plain  foods  arc  quite  enough  in  most  cases.  \Vith 
invalids  some  temptation  may  be  desirable,  or  even  requisite.  P>ut 
of  that  anon.  A  suHicieiicy  of  plain  fnod.  meat  puddings,  etc.. 
should  be  provided :  and  when  this  is  done,  eat  in;_r  bet  wi  xt  meals  at 


IX    YOIT11    AM)    ADOLKSCKNCK. 

confectioners  is  not  neressarv,  and  is  eertainlv  unde-iraMc  for  \oii' 
peoj  ilr  of  eit  her  se\. 

I'ntil   u'rowth  is  completed,  aleoliolir  drink-  should    lie  avoid, 
and   oidv  in  ven  \vlieii    there  is  a  verv  deal1  indication  for  their  i;-r 
and  this  is  nut  like.lv  to  ueeur  in  a  euuditiuu  of  health. 


rUAl'TKU    XIII. 

FOOD    IX    A  DIM /I1    I.IFK. 

AViiKN"  the  period  of  growth  is  completed,  the  dietary  chosen 
varies  with  the  individual,  the  occupation  followed,  the  opportunity 
for  acquiring  food,  and  of  course  according  to  the  appetite  and 
palate. 

Some  broad  rules,  however,  may  be  laid  down.  In  the  first  place 
persons  of  square  abdomen  and  large  viscera  prefer  a  good  sub- 
stantial meal  at  not  too  frequent  intervals,  while  persons  of  thin 
ilank  usually  find  small  quantities  at  once,  and  frequently  repeated, 
suit  them  best.  It  is  just  the  difference  seen  in  steam-engines,  or 
rather  locomotives.  The  express  engine,  running  long  distances 
without  stopping,  has  a  large  capacious  tender  to  hold  the  requisite 
quantity  of  fuel.  Locomotives  which  run  short  distances,  as  yard- 
"Ugines  for  instance,  have  small  tenders;  which,  however,  will  ac- 
commodate what  fuel  is  required  in  their  case.  If  the  engine  with 
;he  small  tender  were  to  attempt  to  do  a  long  distance  its  fuel  would 
run  out:  in  fact  its  tender  would  not  hold  enough  fuel  to  enable  it 
to  do  the  distance.  So  it  is  with  human  beings.  A  wife  of  slight 
phvsique  (with  a  small  tender)  tries  to  accommodate  her  meal-times 
to  the  \vavs  of  her  substantially  built  lord,  and  fails  signally.  She 
must  have  one  at  least,  or  more  meals  betwixt  his  solid  breakfast 
and  his  late  dinner;  she  could  not  hold  enough  to  carry  her  over 
the  long  interval,  if  she  tried  her  best.  She  makes  the  attempt  to 
do  as  he  does,  and  utterly  fails.  She  is  not  built  on  the  same  funda- 
mental plan,  and  cannot  do  as  he  does. 

Men  ditl'er  too;  the  man  of  small  viscera  requires  his  meals  at 
comparatively  short  intervals,  because  he  can  take  in  but  a  small 
quantity  at  once.  Some  savages  who  have  to  cat  as  they  can  procure 
food,  eat  enormous  quantities  at  once,  when  they  get  the  chance, 
and  then  fast  accordingly.  They  break  their  fast  when  they  get 
the  opportunity.  Our  word  for  the  morning  meal  is  "break  fast" 
because  it  breaks  the  fast  of  the  ni^ht.  This  matter  of  eating,  and 
the  large  and  small  tender,  is  far  too  little  considered,  where  a 
number  of  persons  are  living  together.  Jf  it  received  due  attention 


much  discomfort,  if  nothing  more,  would  he  a\oided.  "  \I;i:.-, 
female-  ami  delicate  persons  injure  their  powers  of  digestion  hv  de- 
la\  MILT  their  exercise  till  the  system  is  too  much  exhausted  |.,  pr.,:i; 
liy  it."  (( 'oombe. )  \\'hen  I  was  in  country  |n-:ietiee.  1  noticed  thai 
certain  fanners'  wives  were  alwavs  ill  after  attending  market. 
'I'hev  were  all  o f  the  "  small  temler  "  I  vpe.  'I'hev  hreak  fa-te,  1  earlv. 
hustled  about  at  market,  took  no  mitlilav  meal  la-  usual),  ami  >o 
had  a  racking  headache  lie  fore  thev  ^ot  home,  ami  \vere  "  jiast 
eating"  to  use  t  liei  r  own  lan^'iia^e.  Too  loti^  delay  destroyed  the 
appetite  when  the  opport  unit  v  for  food  came.  Manv  person-;  i-an- 
not  eat  then'  lireakfast  for  this  reason;  the  \<n\<j;  fast  lietwixt  supper 
and  lii'eakfasi  is  too  much  for  them:  such  person-  need  something 
in  the  middle  of  the  ni^'lit.  Some  milk,  with  or  without  mail  ;n  it, 
in  a  juu"  with  a  lid  (so  as  not  to  acquire  ;mv  taint  of  the  room),  am! 
if  t  he  weat  her  is  cold,  kept  warm  under  a  "  teu-eosev."  is  a  ivadv 
and  handv  form  of  food  for  such  persons.  ( >r  some  heef  tea  and 
baked  Hour  may  lie  used  instead.  "('hronic  invalids  ami  persons 
of  a  delicate  liahit  of  hodv,  are  also  familiar  with  the  fact  of  t  he 
animal  heat  and  general  viu'or  diminishinu'  towards  morning.  I>ur- 
in^'  the  prevalence  of  cholera,  both  here  and  on  the  continent.  ;; 
was  often  remarked  that  a  lar^e  proportion  of  the  at  lacks  occurred 
earlv  in  the  morning,  in  persons  who  had  u'one  to  lied  apparently 
well.  "  (( 'oomlie. ) 

There  can  too  be  no  doubt  that  digestion  is  much  (pucker  witli 
some  [x'rsons  than  with  others.  And  this  is  a  matter  which  does 
not  permit  of  more  bem^  said.  It  is  a  matter  of  experience  with 
each  individual. 

In  old  davs  after  a  hard  ti^ht  on  a  lonu"  march,  or  a  (lav's  hunt- 
ing, came  a  Li'ood  feast.  lint  in  our  degenerate  davs  we  cannot  do 
this.  And  with  persons  of  weak  digestion,  it  is  a  piod  rule  to  eat 
les.s,  and  to  be  pai't  icular  about  the  food  bt-ln^  easily  digestible  when 
tired.  Perhaps,  to  eat  less,  and  take  a  little  extra  wine,  is  the  be-l 
plan  to  adopt . 

Meals  must  vai'v  according  to  the  individual.      The  A  n  ^  !o-Sa  \ 
prefers  a  substantial    breakfast.      The   |-'rencliman  and    the  Au>:r.a:i 
like  a  cup   of   cotl'ee  and  a  roll  on  «ji-tlin^  up,  and    then    take   a    - 
stantial    meal    about    eleven    \.M.      Tliev  take  a  second    ^ood    me: 

the  evening.        It    is   Well    to   have  some    fooc  1    earlv.    e<pcc;ali\ 

who  stmiv,  or  work  for    hours    in    the  eai'lv  moniitiLf.        I  he   ; 

rum  and  milk  lirst   thimj'  in  tin1  mornim.:'  reconnncnded 

lives,  often  is  of  the  greatest   utiiitv.  and  enables  them  to  ea'   a  :a;r  \ 


ll'o  MANTAL    OF    DIKTKTK'S. 

good  breakfast:  which  otherwise  they  could  not  do — in  consequence 
of  t  lie  long  fast.  Times  for  eat  ing  must  depend  on  the1  individual 
requirements.  Families  usually  get  on  well  together,  because  of 
family  likeness  to  each  other.  \\  hen  a  stranger  comes  among  them 
then  .-omebodv  is  apt  to  suffer. 

The  difference  in  individuals  as  to  their  food  requirements  has 
been  noted  by  .lames  Henry  Bennett,  who  savs.  "  In  some  persons 
the  digestive  process  being  very  rapid,  frequent  meals  are  required 
even  when  abundant.  For  want  of  food  at  comparatively  short 
intervals,  for  instance,  four  or  five  hours,  sensations  of  sinking  and 
i'aintness  come  on,  and  if  the  desire  for  aliment  is  not  gratified,  the 
appetite  disappears,  and  general  prostration  with  headache  and  even 
nausea  ensues.  In  others,  on  the  contrary,  the  digestive  process 
appear-  to  be  very  slow.  When  hunger  has  been  appeased,  tin' 
desire  for  food  is  long  in  again  making  itself  felt.  Such  persons  are 
generally  satisfied  with  two.  or  at  the  most  three  meals  a  day.  They 
are  often  not  larire  caters,  do  not  require  so  much  animal  food,  and 
can  bear  much  better  than  the  former,  accidental  or  forced  absti- 
nence. "  Elsewhere  in  discussing  t  he  same  subject,  he  writes—  "  The 
food  requirements  of  adult  human  beings  vary  according  to  climate 
and  temperature,  and  according  to  the  activity  of  their  organs;  they 
also  vary  according  to  individual  peculiarities.  Some  persons,  even 
in  health,  digest  rapidly  and  imperfectly  the  food  which  they  con- 
sume. With  them  a  considerable  amount  of  it  pas.-es  awav  undi- 
gested through  the  intestinal  canal,  and  escapes  with  the  fares. 
With  persons  so  constituted,  hunger  soon  returns,  owum'  to  the 
demand,-  of  the  economy  having  been  imperfectly  supplied,  and  a 
fresh  supply  of  food  is  required;  it  is  as  if  half  the  coal  placed  on  a 
tire  had  fallen  through  the  grate.  With  others,  on  the  contrary, 
the  process  of  digestion  is  slow,  and  the  elaboration  of  the  nutritive 
material-  contained  in  the  food  is  complete.  Such  persons  both 
require  less  food,  and  that  food  less  frequently,  inasmuch  as  they 
extract  more  nourishment  from  what  they  take."  And  such  indi- 
vidual peculiarity  is  by  no  mean-  confined  to  human  beings.  All 
who  have  had  mii'di  experience  of  horses,  know  that  some  can  do  a 
Lrreat  deal  »f  work  on  moderate  supplies  of  food,  while  others  "eat 
i  heir  heads  oil'  in  no  time,"  in  stable  language,  and  vet  are  no;  capa- 
ble of  much  work.  And  t  his  seem.-  to  hold  v;ood  of  breeds  of  horses. 
Once  I  ha'!  two  out  of  the  same  marc,  which  were  just  like  their 
mother,  in  the  small  quantity  of  food  they  required,  to  do  their  work 
and  keep  in  -ood  condil  ion. 


FOOD    IN    AbU.T    I.IFK.  !•_'! 

It  is  also  eertain.  that  the  temperament  of  tin-  •  in  dl  \  'id  i;al 
ences  tin-  ta-te  I'll'  and  tin1  amount  uf  fond  taken.  (  »n|i4T,_f!  < 
"tiic  following  imperfect  remarks  "  which,  however,  -•••in  u. 
of  n.imtatmn.  "  \\  lii-i'i1  the  constitution  is  of  a  mixed  iia:nr«-.  <T  ,L 
compound  n f  two  or  more  temperaments,  a  <iiet  eompi>-rd  of  animal 
and  vegetable  aliment  in  nearlv  ei|iui!  proportion-  i-  uiuirr  nr.;li.arv 
circumstances  the  l>est.  ilnt  where  any  one  temperament  predomi- 
nates, the  diet  onu'ht  to  he  modified  accord  hiLrlv.  \VlnTe,  f»r  c\- 
ampii'.  the  sanguine  const itution  pi'evail-.  and  is  ehara'-teri/.i'd  !i\-  a 
tlond  complexion,  ^reat  activitv.  .-trmii:"  action  "!'  thi-  ln-ari  and 
Mood-vessels,  and  a  consci|iicnt  lial'iiitv  to  diseases  of  exciti  iip-nt 
and  inllaminatioii,  the  food  oii^lit  to  \>f  lialiit  uailv  of  a  k;ipi  calcu- 
lated rather  to  soot  he  than  to  .stimulate.  Red  meat-,  spices,  \vines, 
and  fermented  liquors  oin:lit  to  lie  n-ed  spariniriv:  and  the  prinejpal 
sujiport  to  lie  derived  from  refreshing  >oiips.  ii>h.  mucilaLriiious 
vegetal  ties,  acidulous  fruits,  and  diluting  drink-.  In  the  case  of 
lymphatic  person-,  on  the  other  hand,  where  the  circulation  is  u.-ak 
and  slow,  and  ail  the  funetioiis  are  feeble,  the  system  is  bein-iited 
i»v  the  stimulus  of  a  larger  propm-tion  of  animai  fond,  e.-peeiads  red 
meat  and  ^ame;  while  vegetables,  soups,  aiui  tluids  nf  a.l  kind- 
prove  relaxing  and  hurtful.  Aromatics  and  spice.-.  howe\cr.  are 
useful,  as  is  also  wine  in  moderation,  and  conjoined  \\;:h  aiieiaiate 
«'\eri'ise.  If  aLi'ain.  the  individuai  presents  a  h,!_rhiv  nervous  teni- 
peraineiit.  chanieteri/.ed  by  delicacy,  unusual  sensibility  to  impre.— 
.-ions,  and  ^reat  cxeitahilitv.  witluuit  proporl  innate  strength,  -ueli 
as  is  often  seen  in  females  and  :n  men  of  genius,  care  on^iit  in  i'C 
taken  not  to  make  use  of  a  heating  or  st  imiilat  in^  regimen.  \\'IL;C 
meat,  sueh  as  li-h  or  fowl,  are  more  suitable  than  ihe  k;nd- 

nar\'  us".      Siijer-  arc  also  hurtful,  but   farinaceous  and  mue:.a^',!;i'i;.- 

• 
aliments  and    ripe   fruits,  are   LTl'iierall v  admi>.-ib!e,      alwa\.-  .-upp"-^ 

IIIL;'  that  moderation    in   Muantily  is  attended  to.  and  that    the   m...;e 
of    life    is    in   ot  her  respect-  regular  and    rational.      \\hen    tin-   . 
bilious   temperament     predominates,    and     miieh     bouiiv    i-\. 
the   open    air   is    ciijovcd,    more    latitude    in    the    eho.n-   c.; 
ad  in :--;!  lie.  than    in    anv  other  constitution."      \\  ;th    th:- 
mn.    however,    I    can    not  i|iute   a^'i'ee,    as    m\    i-xiier'i-ne. 

ill     ;  he     din-el  ioll     t  hat      liiliolis     people     do     not      do     U  e         o" 

of  aibuminoid  food;  a  mallei1  that   will    be  di-eu-^d  1,1,1  ; 

ter.      Utherwi-e  what    \>r.  Ctioinbe   say-'iii,le 

I'ieliee. 

The  haliits  and  food   cu-t<  'in-   uf   t  he 


ll'-J  ^lANL'AL    OF    DIKTKTICS. 

culated.  and  form  a  matter  of  some  importance,  which  those  \vlio 
meditate  foreign  travel  too  often  neglect.* 

Or.  I>ennett  writes,  ''Just  as  the  stature,  features,  and  bodily 
proportions  assume  a  characteristic  peculiarity  in  each  individual 
during  the  period  of  growth,  so  the  organic  system  also  receives  its 
stamp,  the  result  of  earlv  habits  which  usually  last  throughout  life. 
The  habits  of  organic  life,  if  we  mav  so  term  them,  are  partieiilarlv 
marked  in  the  digestive  svstem.  A  man  who  has  been  brought  u[> 
to  the  adult  age  on  a  very  animali/ed  dietarv.  in  after  life  requires 
such  a  dietarv  more  than  one  who  has  lived  principallv  on  vegetable 
food.  Again,  the  one  who  lias  been  accustomed  until  middle  age 
to  eat  often,  mav  not  with  comfort  and  advantage  be  able  to  supplv 
the  wants  of  his  system  by  two  meals  only:  and  yet  this  system  of 
feeding  may  perfect  ly  agree  with  his  neighbor  carlv  inured  to  it.  Thus 
it  is  that  the  Herman,  the  Frenchman,  and  the  Knglishman  become 
habituated  to  the  food  and  food  hours  \vhich  obtain  in  their  respec- 
tive countries,  and  that  their  digestive  powers  often  give  way  when 
thev  change  their  residence,  and  endeavor  to  conform  to  the  novel 
habits  of  their  new  place  of  abode. 

"  These  facts  were  well  illustrated  bv  Avhat  occurred  during  the 
Franco-Herman  War  (1809—70).  .Many  thousand  French  prisoners 
were  put  on  tjie  usual  dietary  of  t he  Herman  soldiers — sausage  meat, 
coarse  bread,  and  beer.  The  common  soldiers,  peasants,  and  artisans, 
accustomed  to  a  coarse  and  spare  dietary  at  home,  did  very  well, 
throve;  but  it.  was  not  so  with  their  officers.  The  latter  became 
dyspeptic  and  ill.  and  in  manv  cases  their  health  was  broken  down 
and  ruined.  1  have  attended  at  Mentone  several  in  whom  the  seeds 
of  fatal  diseases,  principally  phthisis,  were  then  sown." 

To  a  slightei  degree  the  same  thing  was  seen  with  the  Anglo- 
Americans  who  were  studying  in  Vienna  the  winter  the  writer  was 
there.  Himself,  a  hardv  North-countryman,  got  on  well  enough; 
but  neariv  every  other  one  complained  of  the  food  being  indifferent, 
and  were  more  or  le-s  out  of  sorts  from  it,  if  not  actually  ill. 

On  the  oi  her  side  may  be  quoted  a  case  which  ( 'oomlie  took  from 
Jleidler-  "A  v  mug  woman  of  healthy  constitution,  brought  up  in 


*  Wh.'ii  -i  in  it  >  i  if  i||..  inliMbitaiits  of  St.  Ki  Ida's,  a  u  ild  n>ek  in  the  Atian- 
tie  far  away  In  tin-  \VI-NI  n|'  iln-  1  {ebrides.  emigrated  to  Australia,  it  was 
1(/uiid  "  1  hey  ei  MI  Id  i  ,n  I  v  in-  |<i-|)i  iii  IHM  It  1 1  liv  an  <x -rational  meal  of  1  IK-  rank 
«'L:'u's  and  dried  pullin^  1  ln-v  earned  with  tln-m."  While  I'"inn  recruits  in 
Ku^-ia  nii»  th''  Imvli-liark  in  tln-ir  brown  liread  on  leaving  home. 


FOOD    IN    AIH'l.T    I. IKK. 


all   tho  simplicity  of  country  habit-.  pas.-ed  at  once  on  her  m,     '.'.-.t^- 
to  a  less  active  mode  of   life,  and  to  a  much  mop-  c;.-^;ii!i   ta'>  ••.       I\ 
a  >hort  time  she  he^an  to  complain  of  irritability,  la>-  itudc.  \-,r.. 
spasmodic     sensations,    ati'l     habitual    con.-t  ;  pat  ion.        1  1  \  p<  ichon>ir  • 
was    sonii    adilcil     to    oilier    symptoms;    her    hope    of    hcci>miii'_r    a 
mother  bciiii:'  always  deceived.       An   additional    i;!a--   of  wine,  hark, 
and  other  tonics  were    ordered.      The    evil    increased.      The    pat  ;,•;.• 
liecame    melancholic,  and    believed  that    she  was   ahvavs   swallowing 
pins.       In  the  course  of   the  year  she  became    so   emaciated  and    vel- 
iow    that    her    mother,    who   had    not    seen    her    for   eleven    month.-, 
could    scarcely    reco^u/e    her.       After  an    eighteen    month-'   emir-e 
of    purgatives,    and    two    courses   of    .Marienbad    water,  she    entirely 
recovered.  " 

The  same  thniLT  is  commonly  seen  in  country  cfirls  connnir  into 
towns  to  sedentarv  occupations:  and  yountr  fellows  abandoning  an 
active  life  to  wait  behind  a  counter  —  especial!  v  in  rooms  inditl'ereiit  '  v 
ventilated.  "The  operation  of  the  same  principle  is  c((iially  con- 
spicuous in  i^ir  Is  sent  from  the  country  to  t  lie  work  -rooms  of  fash  ion  - 
able  miliinei's  and  dressmakers  in  the  larger  to\\ns."  \\ith  little 
exercise  they  rei|iiire  less  food;  but  if  the  appetite  keeps  up.  head- 
ache, sickness.,  biliousness,  indigestion  and  constipation  are  apt  to 
follow.  Strong  and  healthy  fellows  who  conn-  up  fruin  tlu-  country 
t<»  sedentary  trades  and  occupations  also  require  and  -jet  some  un- 
pleasant experience  before  thevcaii  adapt  themselves  to  their  new 
form  of  life  with  its  novel  needs  and  requirements.  The  same  is  found 


bodily  labor  comes  to  luxury  and  dines  out.  while  he  settle.-  down 
to  a  sedentary  life  to  put  his  book  through  the  press.  He  -oon 
linds  that  his  new  life  makes  new  demands  upon  huii.  with  winch 
he  must  comply,  or  pav  the  penalty.  l.iii'ht  fond  of  a  kind  likely 
to  keep  the  bowels  open  (see  a  later  chapter  for  this),  is  the  a.iment 
which  wil  1  keep  him  in  heal  t  h. 

Then  comes  the  relation   of   food    to   climate.      In  tropical   coun- 
tries   tin1    carbo-hvdrates    form    the    staple    of    food.        In    temperate 
climates  a    mixed    dietary  has    been    adopted  a-  the  result    o]    c\ 
cnce;    while   in  Arctic   regions  the  concentrated    fuel-food    ha-   been 
found    the  only  food  that    will   sustain   life  amidst    the   inten-e  cold. 
The   stomach    of   an    Ksijtiimaux    couid    not    hold    enough    o!         "•«>• 
hydrates    to   preserve  him  against  star\ation  in  the  low    surroun'i  ;nir 
temperature.       Liebi^    pointed    out    that    the   carho-h  vdrate- 
tropics  contain  only  some    1  '.'    [icr  cent,  of  carbon.      'I  he 


ll'l  MANTAl,    (>!•'    DIKTKTICS. 

of  the  Ksquimaux.  blubber  ami  oil.  contains  from  i>0  to  SO  per  cent, 
of  carbon:  consc(|iu'iii  1  v  AVC  can  readily  understand  the  preference 
manifested  for  fat  in  Arctic  regions — for  heat-generating  material 
indeed.  There  is  no  taste  for  sweets  in  these  Northern  dimes,  and 
Sir  Anthonv  Carlisle  found  that  even  babies  there  had  no  taste  for 
sugar,  spluttering  it  out  of  their  mouths,  "while  the  little  urchins 
grinned  with  ecstacv  at  the  sight  of  a  hit  of  whale's  blubber."  All 
Arct  ie  voyagers  have  fotiml  the  necessity  for  following  the.  Ksquinuiux 
in  the  diri'ction  of  eating;'  fat  in  liberal  quantities. 

The  importance  of  this  matter  of  climate  and  food  require- 
ments is  illustrated  !>v  the  need  for  varied  stores  when  bodies  of 
men  are  sent  out  on  expeditions.  According  to  the  temperature 
so  must  their  food  supplies  be  furnished — as  to  qualitv  and  quan- 
tity. 

And  closely  linked  with  this  matter  comes  that  of  the  relation  of 
food  to  work.  It  has  been  pointed  out  before  that  both  with  men 
and  horses  more  nitrojjenised  food  is  required  when  active  exertion 
and  hard  toil  have  to  be  endured.  We  see  the  farmer  raises  the 
allowance  of  oats  to  h;s  horses  at  ploughing  time.  The  Aral)  gives 
his  horse  barley  and  camel's  milk,  and  if  great  elfort  be  required, 
even  camel's  llesh.  The  horses  used  in  Sahara  to  course  ostriches 
get  camel's  milk  and  dried  beans.  (Paw.)  This  is  a  very  highly 
nitrogriiised  food  material,  but  the  excess  of  nitrogen  enables  the 
horse  to  make  rapid  movement-.  The  muscle  itself  does  not,  wear 
out  in  exertion,  as  was  once  supposed.  Traube  held  that  the  muscles 
burn  up  hydro-carbons,  as  fats  or  carbo-hydrates.  Possibly  the 
store  of  glvcogeii  is  the  fuel  of  the  muscle  when  at  work.  "The 
muscles  appear  to  stand  in  the  position  of  instruments  for  effecting 
the  conversion  of  the  chemical  energy  evolved  by  the  oxidation  of 
combustible  matter  into  working  power.  While  admitting  that 
hvdro-earbons  are  the  fuel  which  produce  heat  and  force,  the  neces- 
sity for  albuminoid  materials  for  hard  exertion  has  also  t;>  be  recog- 
ni/ed:  a~  albuminous  food  produces  firm  muscles,  so  exercise  makes 
them  hard.  To  .-um  up.  science  intimates  that  a  liberal  supply  of 
nit  rogenised  matter  is  necessary  to  produce  and  maintain  muscles  in 
a  gin"  ci  •  nil  for  work,  and  the  result  of  experience  is  to  con- 
firm it.  "  (  Pa  \  y.  ) 

This  brings  u-  face   to    face  with  exertion  in  cold  climates.      The 

maiix    consume    much    lean    meat    with    their    fat,    without    in- 

\\  e    '•'      undcr.-tand    oxidation    being    very   active    in    Arctic, 

<•.  me-;   and    a-  \\:\<  been  >aid    before.  MJ  long  as  the  liver  can  convert 


t  lie  waste  or  surplus  albi 
well. 

If  the  muscle  itself  .Iocs  not  weai'  out.  what  is  the  rca-on  :h,v 
nitronvntsed  food  is  essential  for  severe  exertion:'  It  -ecin-  ;.,  nic 
t  he  answer  must  lie  found,  in  the  stimulant  eiTeets  of  kivatin  and 
kreatinine.-  the  stimulant,  factors  of  beef  t,-a.  Thc\  are  f, ,.-,., 
liberalors.  and  so  enable  the  system  to  ^vt  ai  it-  stored  force  mo;-,- 
rapidlv  and  reaililv.  And  a  certain  proportion  of  tiiem  :ses~ent;a; 
to  active  cll'ort.  Navvies,  lightermen,  and  others  who  work  very 
hard  have  found  t  hat  a  considerable  octant  it  v  of  meat  in  i  heir  d  ietarv 
is  essential  to  enable  them  to  undergo  tlieir  toil.  1  >r.  .lames  ll. 
Bennett,  in  discussing  this  subject .  savs—"  1  was  told  by  a  n  eminent 
railway  contractor,  that  when  some  of  his  navvies  were  first  taken 
to  work  on  French  railroads  it  was  found  that  they  could  do  in  the 
same  t  i  me  double  the  amount  of  work  °'ot  through  by  the  French 
workmen,  who  lived  in  a  much  more  sparing  manner,  and  princi- 
pally on  bread  and  vegetables.  The  French  sub-contractors  wcr- 
obliged,  in  order  even  partly  to  efface  this  dilTereiice  wonndm-- to 
their  national  pride,  very  considerably  to  increase  the  dietarv  of 
their  workmen,  and  more  especially  to  nit  ro^'einse  or  an;maii-e  it. 
By  adopt  ins;  this  course,  the  French  workmen  very  soon  increased, 
their  muscular  powers.  The  materials  for  greater  muscular  devel- 
opment bemii'  LTlven,  and  the  lliuseles  at  the  >anie  time  freelv  exer- 
cised, the  organic  nutritive  flianires  became  more  rapid,  the  muscles 
increased  in  compactness  and  volume,  and  the  work  power  increased 
in  proportion."  This  reminds  one  of  I'avv's  story  of  a  farmer  who. 
when  asked — "  how  it  was  that  he  paid  his  laborers  so  well  I'"  re- 
plied "  that  he  could  not  afford  to  pav  them  less,  for  he  found  thai 
less  wa^es  produced  less  work."  The  old  Northern  farmers  alwav- 
kept  a  liberal  table,  say 'MILT  -"*  Work  <foes  in  at  t'mouth." 

Sir  I  .von  I'lavfair  some  years  au'o   took  up  the  subject    "On  ;';. 
Food    of    Man    in    relation    to    his  useful   Work."      He    found    tha: 
'' Subsistence  diet "   for   persons  who  were   not   doin<i  anv  work    ran 
about  as  follows:  — 

\it  roLi'enous  matter,  ....        '-'.  "•'-    o.x. 

Fat.   ' I'.-l    • 

( 'arbo-hvd rates, 

I  •vnamic  value  in  \'< » <\   tons.  '.'.  \~>'-\. 


ll'ti  MAM" AT,   OF    DIKTETK'S. 

Nitrogenous  matter.         .... 

Fat 

Carbo-hydrates iS.tiiU)    " 

Mineral  matters 0. ;  14      " 

Dynamic  value.  4. (I'M  foot  tons. 

Diet  of  active  laborers,  including  that  of  soldiers  in  Avar  time: 

Nitrogenous  mutter,          ....       .\41  o/. 

Fat -1.4]  " 

Carbo-hydrates 17. '.Ml  " 

Dynamic  value.  4.4.">S  foot  tons. 

In  this  last  it  will  he  seen  that  the  force-liberator — the  nitrogen 
— is  considerably  increased:  and  that  the  concentrated  heat,  or 
force  food  (fat)  is  also  notably  increased,  with  a  fall  in  less  concen- 
trated hydro-carbons. 

Dr.  1'arkes  found  the  food  of  the  English  soldier  on  home  ser- 
vice to  be: 

Nitrogenous  matter,          ....  :>.Si>    ox. 

Fat !.:;<>     ;> 

Carbo-hydrates,         .....  K.:!4     '' 

Mineral  matters. 0.808    " 

which  is  very  close  to  Sir  Lyon  Playf air's  estimate. 

From  these  we  can  form  useful  broad  rules  as  to  the  dietary  of  con- 
victs (not  doing  hard  labor)  and  persons  in  workhouses.  While 
comparatively  short  rations  will  do  when  no  labor  is  exacted:  a  more 
liberal  dietary  becomes  necessary  when  work  has  to  he  done;  and 
when  verv  severe  exertion  is  expected  the  dietary  must  lie  still  more 
1  literal  hot  h  as  to  force-liberators  and  force-producers.  The  capacity 
of  ihe  Fnglish  soldier  in  war  has  ahvavs  been  looked  upon  as  closely 
linked  with  Ins  commissariat.  Prowess  and  food  go  together,  of 
course  the  cpiestion  of  food  can  never  be  separated  from  that  of 
clothing  in  cold  climates. — the  more  that  is  required  for  the  heat 
tin-  less  is  left  for  force-production.  The  native  of  Arctic  regions  is 
clad  in  furs  in  order  to  reduce  his  heat  loss,  and  so  lessen  the  demand 
upon  his  fuel-stores,  Fven  then  lie  needs  liberal  quantities  of  fat. 
(the  concent  rat  I'd  fuel  -food ).  About  twentv  pounds  of  meat  and 
b, libber  per  dicin  is  the  ordinary  allowance.  And  Sir  John  Ko~< 
found  t  hat  a  1  afire  con  sum  pt  ion  of  "  ( ireenland  food  "  was  1  lie  road 
to  .success  ni  fro/.en  countries.  "  The  'plant  it  v  of  food  should  be 


FOOD    IX    ADl'LT    Lll-'l-:.  l'J7 

increased,  be  that   as  inconvenient   as   it   may;"    and   of  ci.ur-e 
economise  food  l>v  suitable  clothing  as  far  as  possible. 

On  the  other  hand  the  Knjrlishman  who  will  persist  in  tlf  dietary 
and  especially  "the  roast  beef  of  old   Kn^iand  "  in  tropicai  e,imates 

sooner  or  later  falls  ill   with  some  hepatic  trouble;    I aii-c  hi-   liver 

cannot  deal  effectually  or  successfully  with  the  albuminous  food 
which  he  consumes  far  in  excess  of  his  bodv-wants.  1  n  ( I  iv-nlaud 
he  would  hunger  to  death — be  entirely  burnt  up  "stork,  lock,  and 
liarrel  ''-—ill  two  or  three  days  on  a  dietarv  aniplv  siitlieient  for  the 
plains  of  Bengal,  or  the  (luiuea  coast.  And  fire  n-rxi'i,  a  (Ireeniand 
dietary  would  pall  on  the  appetite  in  tropical  climates. 

"There  can  be  no  doubt  that  a    lar^'e  proportion    of  the  disease.-- 

i  I  1 

of  the  digestive  apparatus  which  are  so  fatal  amon^  Kuropean  iv.-i- 
dents  in  India  and  other  tropical  climates  result  from  the  habitual 
inirestion  of  a  much  larger  quantity  of  fooil.  and  this  especially  of  a 
rich  and  .stimulating;  character,  than  the  svstem  requires.  The  loss 
of  appetite  consequent  upon  the  diminution  of  the  demand  for  com- 
bustivc  material,  is  set  down  to  the  deleterious  elTect  of  the  climate; 
and  an  attempt  is  made  to  neutralise  this  bv  artificial  provocatives/' 
(Carpenter.) 

Taking  his  statement  '''  that  about  two  pounds  of  bread  and  three- 
quarters  of  a  pound  of  meat  are  amplv  sutlicient  to  compensate 
the  daily  losses  of  the  system  in  a  healthy  man"  (in  a  temperate 
area),  we  can  see  that  considerably  less  than  this  is  enough  for  the 
hot! v  wants  in  a  tropical  climate;  and  that  much  more  will  be  re- 
quired to  maintain  the  bodv  heat  in  the  Arctic  regions,  especially  if 
considerable  exertion  is  also  entailed. 

Women   as  a   rule  eat   verv  much    less  than  men.      They  lead   an 
indoor  life,  usually  in  warm  apartments;    they  arc  smaller  in  frame, 
and   lighter   in    weight ,  and  consequently  require   less    food.      \\iicn 
women   are  out    much    in   the  air,  either  as   ladies  hunting  or   field 
hands,  t  heir  needs  are  increase!  1.  and  substantial  meals  are 
and  usually  are  taken  —  bv  the  ladies  at  least. 
i/.ed    tribes,  women   often    perform  much   of 
probably  take  food  accordingly. 

The   clerk,    cooped    up    for    many    hours    daily    in    a    warm    otli 
(often    up  lo    it)'    l-'ahr.  ).  requires   eomparat  i\  eiy  small  quantities 
food :    the  same  may  be  said    of    the    miii    hand    and    the   ar!,-an. 
haudici-aftsman  working  indoors.      \\\\\  for  the  field  liaiid.fi 
and    tlie  lighterman,  and  the  soldier  on  active  service,  a  i 

\vnrkniL1'  eniiiii 


ll'^  MAM'AI,    ()!•'    niKTKTK'S. 

persons  performing  litiic  pliysicjil  toil  the  food  should  consist  largely 
of  earho-hvdnites  in  the  form  of  farinaceous  food,  with  sonic  nitro- 
gen such  as  a  tish  diet  could  supply,  ami  a  little  animal  food.  Of 
course.  where  tlu-rc  is  aiiv  tendeiicv  to  tissue  degeneration  (phthisis 
or  sci-ofula),  a  certain  quantity  of  fat  is  desirable.  lint,  with  all  this 
calculated,  we  nui-t  still  reckon  with  the  disturbing  factors,  the 
"palate"  and  the  "appetite."  which  will  rule  the  roost  with  many 
persons. 

In  a  vegetarian  dietarv,  the  legumes  (rich  in  nitrogen)  take  the 
place  of  meat,  while  oil  supplies  fat:  and  mineral  salts  arc  furnished 
bv  vegetables,  as  cabbages.  No  doubt  a  great  deal  of  excellent  work 
has  been  done  bv  vegetarians;  ;ind  a  great  manv  people  would  do 
wisely  bv  becoming  seiti i-vegetaria us.  at  least,  especially  in  warm 
weal  her-  — t  he  \\  n;  er's  o\vn  personal  practice,  lint  then  there  are 
to  be  heai'd  so  many  other  voices,  including  those'  of  the  housewife 
and  the  cook  than  that  of  Science  on  this  topic  ! 

Then  comes  the  matter  of  the  opportunity  of  acquiring  food. 
This  is  a  matter  which  can  scarcely  be  discussed  at  length  here.  It 
is  a  well-known  fact  that  stockmen  and  miners  have  very  often  to 
live  on  undesirable  food,  as  "damper."  Flour  cakes  are  indigesti- 
ble, and  pancakes  have  been  the  ruin  of  manv  a  stalwart  fellow,  who 
ate  them  because  he  could  not  get  anything  else. 

The  subject  of  the  food  requirements  of  adults  may  litlv  termi- 
nate wit  li  soi  ne  oo  n-id  era!  ioiis  of  the  tendency  of  the  a  ire.  \\"e  have 
not  :_ro t  the  internal  arrangements  of  our  ancestors,  and  cannot  deal 
with  the  quantities  of  food  they  ate  apparently  without  ill  clVect. 
And  this  is  .-peciallv  true  of  meat  and  alcohol.  There  is  a  wide- 
spread movement  towards  ''Vegetarianism"  and  "  Teetotalism  " 
ainoii'jr  the  Anirlo-Saxon  race  at  least;  and  this  must  have  sonic  act- 
ing agent.  Ina  little  work  published  some  time  aur<|.  ("The  l-'ood 
we  Mat  ")  the  writer  speculated  as  to  the  dietary  of  A.  I),  •.'ono. 
\\  hat  H  put  there  in  a  li^ht  and  jocular  manner  is  however  what  he 
seriously  believes  will  be  the  ease,  and  what  we  are  COUIHIL;'  to.  Hut 
of  course  the  spirit  of  the  axiom,  ''the  future  must  take  care  of 
itself"  prevents  anvoiie  from  taking  any  steps  for  their  potential 
descendants.  For  the  bulk-  of  persons  a  lighter  dietarv  consisting 
largely  of  cooked  farina  (otherwise  predigested  starch)and  milk  will 
probably  be  found  the  bc-t.  Hut  for  tho-e  engaged  in  literary  work 
some  doubt  mav  be  expressed.  "  The  irnm  old  millers  of  the  tongue 
and  pen  "  were  caters  of  meat  and  drinkers  of  wine;  and  Carpenter 
states: — 


*'  . \iiil  while  on  tin'  other  hand  il  mav  !>e  fivi-lv  eoneeded  to  th- 
ud vocal es  uf  'Vegetarianism'  that  a  well  selected  ve^'taMe  die! 
eapahle  <>\'  pruiliicin^  (in  tin-  iri'iMtn-  iiiMiilici-  <•!'  i!nii\  i«li;aN)  th. 
hiirhfsL  phvsical  <lt'Vfl()|iincnt  nt'  \vhicli  tlicy  ai-f  rapatih-,  it  IIKIV  !»• 
on  tin'  other  haml  aHirnu-il  \\ith  ci|tia!  rcrtaintv,  that  the  suh-ti- 
tution  <>t'  a  nTtain  projioi'tion  «!'  annual  llt-sh  i-  in  \\<>  \\av  injiinmi-1. 
\vhili'  so  t'ara-onr  cviili'iirc  at  present  extend-,  this  serins  raih'T 
to  favor  the  highest  mental  development." 

So  much  then  for  the  food  wants  of  in'own  man  under  tin-  various 
(•nvumstaiieer-.  of  oeeupatioii  and  eii\  iruiinieiit. 


CHAPTER   XTV. 

FOOD    IN    ADVANCED    UFK. 

"A  MAX  loves  the  meat  of  his  youth  that  lie  cannot  endure  in 
his  avv. " 

So  said  that  most  remarkable  observer.  Shakesjteare.  Ib>w  he 
ever  found  time  and  opportunitv  to  observe  all  he  did.  is  a  marvel 
to  ordinary  mortals.  This  observation  too  is  perfect  Iv  accurate. 

There  arc  a  <jood  many  reasons  for  the  inability  in  ap'  to  cope 
with  the  dietarv  of  vouth.  AVe  saw  in  the  last  chapter  the  relations 
of  the  food  to  the  individual,  his  work  and  his  environment;  and 
can  applv  its  lessons  here.  As  aije  advances  the  energies  wane.  The. 
capacity  to  take  exercise  or  undergo  (oil  is  enfeebled,  and  the  in- 
clination to  do  so  also  lessened.  A  man  pleads  he  "  is  not  so  vouns^ 
as  he  once  was."  His  limbs  are  stilfer  and  his  wind  is  not  so  v;ood. 
Some  certainlv  retain  their  vipir  till  a  verv  old  air*1,  and  with  it  their 
digestion  and  their  gastronomic  ardor.  In  mv  davs  of  earlv  practice 
in  the  North  of  Kn^Iand.  there  was  an  old  gentleman  of  the  old 
school,  and  the  habits  and  practices  of  the  Iiep-ncv.  1-Yoin  earlv 
morn  till  dewv  eve  he  sturdily  walked  throughout  the  dav  in  order 
that  lie  miirht  cnjov  his  late  dinner.  His  bell  was  his  ^od ;  and  he 
was  an  earnest  faithful  worshipper!  It  was  not  a  lofty  creed  but, 
it  could  inspire  conduct:  and  that  is  the  highest  terrestrial  etTect  of 
a  creed.  He  walked,  he  ate — and  what  is  more,  ate  with  impunity; 
and  died  a  nonop-narian.  After  all  it  was  a  piteous  si^'hi  to  see  the 
old  patrician  tramping  a  Ion  <r  in  all  weathers  with  his  dinner  before 
him--  an  object,  however,  which  could  hire  him  to  undergo  ail  the 
inconvenience  of  exposure  to  bad  weather  in  a  tempestuous  locality. 
1 1  is  ambit  ion.  such  as  it  was,  was  irrat  iticd. 

At  iir.-t  "  llie  turn  of  the  hill  "  is  scarcely  noticed,  and  perhaps 
the  oldv  diH'erence  is  that  the  individual  doe-  not  come  twice  to  the 
joint.  I'rohahlv,  too,  the  once  cherished  draught  o|  ale  is  no  longer 
so  keen'v  reli.-hed.  A  slighter  excess  of  alciihol  is  felt  next  morning 
than  of  voi'c.  I'erliap-  LTout  ba  i  ;  h:m  to  leave  oil'  jiort  wine. 

Hut  as  years  cree])  on  the  alteration  In'comes  more  marked;  the  ap- 


petite  irencrallv  is  impaired  :   tin-  palate  lose-;  its  once  k ,  ed  ••:••:   a 

thr  skill   of   tlie  conk  is  no  lunger  so  successful  in  lirkiin^ 
and  tiie  appetite;    hut    as    tin-  latter  fails   so    the   ^"nrmand 
more  particular  about  lus  dishes. 

The  teeth,  ton,  fail:    ami    tin- strong    meat   "  ^iviiiLT  a  Lr|""i 

IS     lio     longer     So     easllv     IlUlStieated.         (  'oliseouent  iv   <//'/•'>-      take     t: 

place  of  the  joints,  the  steaks  and  chops,  on  v  so  eau'erlv  de\ouiv> 
Spoon-meat  is  found  more  acceptable  in  evi-rv  \vav.  More  eond 
incuts  are  i'ei pi  i red.  ami  hitrhlv  seasoned  dishes  find  favour  for  iu»! 
reasons  tlian  one.  Flatulence  is  the  ham-  of  advancing  vear.-:  a;: 
for  this  the  cook  can  do  much.  There  ;.-  a  tendeiicv  to  constin 
tiou:  and  that  too  is  a  matter  I'm'  which  much  can  be  done  in  ti 
kitchen. 

1'iefore     proceeding    f  11  ft  lief   i  L  Ilia  V   1  ie   \\'ei  1     to    (plote     frotii     "T! 

Diseases  of  A'ivanced  LitV'"  hy  Dr.  .Mcl.achian.  on  the  anatomic 
changes  which  -jn  on  in  the  viscera  in  a^e.  "  I'art  icipat  IIIL:  m  '1 
general  wasting  of  t  lie  organs  and  tissues,  the  stomach  and  iutc-t  iin 
lose  hulk  and  hecome  thinner  in  oid  au'e.  Their  glandular  appar; 
tits  is  also  atrophied.  Many  glands  seem  to  ha\  '•  cut irel v  d;.-appeaiv< 
The  \vastinir  ni'  the  tunics  composing  the  stomach  and  iniesiines 
moi'e  obvious  in  the  duodenum,  jejunum,  anil  ileuni.  In  some  ca- 
it  is  carried  to  such  a  decree  as  to  admit  of  the  contents  of  the  i: 
test  nies  beiiiLT  (1>ist  met  Iv  seen  through  t  lie  attenuated  structure-.  1 
striking  contrast,  the  larger  intestines  oceasionally  [>n-serve  the 
natural  thickness,  dnetlv  throii'di  a  compensating  hyp'Tt  ropiiv  > 
the  mu.-cular  coat.  The  miii,-ous  niemhrane  i<  usuailv  paler  than 
t  he  ad  ult .  and,  general  1  v  aeipti res  an  ash  Lfrav  colour  a-  life  an  vane.' 
In  the  .-toinach  it  is  often  traversed  hv  eniar^'ed  ve;n~.  a.~-ii!i;;-;^ 
varicose  character,  \vhich  heeome  more  Tiumcrmis  m  the  lo\v;-  po 
tions  of  the  intestinal  canal,  and  are  part icularlv  conspicuous  to\van 
the  termination  of  the  colon  and  rectum." 

Such  anatomical  details  tell  us  thai  the  1'iinct  ainal  ac;:v::v 
digestive  organs  mu-t  he  much  impaired  in  au'c.  The  a1'- 
act:onmtist  he  cripjiled  bv  tlie  stairnant  current  in  the.-\vo].en 
The  glands  of  the  small  intestine  are  atrophied.  Co1,- 

initrition  must    In-    less    perfect,  an^l    the  ; !    miisi       ••   o; 

readily   annullable    character.       No    \\onder 


MANUAL    OK    niKTKTK'S. 


:    :.•.<!   the  a'-:ion   .  :'  :'.-•  l...v.  d-   ren<lere.l   -"_•_--':.     Th<>'i  the 
••:'  ; .  ••  .   \vi  r  -:  favor  piles,  an  i  nther  maladies  at 

or  i         "         v.>. 

T:  ••  ni'iral  of  all  :h's  is.  that  the  as.similative  orpins  a-  years  a<l- 
van  ••  arc  M<  ;  •    "•  '.  t"  [rivat  lit-niamls  in   >n  thcni.     T<>  fas:  t"  t-niov 


;•.;.::.   :;r.:  an- 1   takt-y.   a  I    n»:  ' r-  >  '.•  :.  _'  ir.t-.-rva'.s.      "  <  hire  a  nia:;  an<l 
"  .-ay>  ':.••  n.i]  mlairc.      A:.  ;  tin-  ilii-tary  of  T:.'1  very  nM 
;-  •'.•••  n. or./  •      •          the  nursery.      l\-rhai'.s  nmn-  eondinn'iit-  are 
:  '  ::a:i  "f  yore:  1-ut  tin  n  tliat  ajrain  is  a  return  t"  early  .lays. 

Tile   •'   '     ei     •  of    Ir.faivy  returns   ::.  a-lvaii'vl   life:    an.]   the   !'<>."! 
must    In-   i're]iare.]    a  ••":••;:?. _ly.      Sni;    1    nieals   i-fi    rtM-eated   iie.-«>me 

Wlu-n  any  riinsi'lerable  luilk  «'f  :' 1  is  eon~ume>I  a;  i>nce 

_::•••:;•  •    -  r  ,'•:•":'  the  a! ;ir.entary       •_•      s  se:  up.      Tlien-  :>  iliarrhu-a 
— ?'.v.          _-.••••'••    :  :._  m;  -  ;  •  _    •  in-'  li- 

nn:   rir  tin-re    -  "iisT  nate  i-on>:;i  ;•'.-•..  when  ;:.••  ;  "We!  :-  un- 
•          ..:._•  ::.--.'  >u  \.      [n  eitlier      -  ••  is  ;r.  <i  :o 

v        -  •  :  •.    rious  ki1    is.  :  ro\v!^.  ;!.:.•:  whit",  thi  'k  a:.  I  •  Irar.  «'i  :'.•  sh 
or  i'.-h.       _ :  '  •  '  '      !in !.:   n   !>i>.'u:t.  nr  s.  ane  .••;n:\';(- 

•    .::;  ••  nn  !:<  i    i-urt'-r.     ( '.  n  >  >.;'  far 

•  :.-•   ras.'  •  •  any  U!":1'- 

:  :?iv    :  U.      P.  .  nr  ;,  - 

.••;.-::.••-•  •  >.:••:•.  <  .r  eauli::     v--r 

nr  -  .::  •    '  '    '    ••:  •-•':.'.>•  -.  'li.  •  '  '-        '  I      r  <•    Iil'.O-t.-  ':.i' 

••'_.••••.-'-•":'  :i   .-!na!l 
.    !'",'l'li:;ur. 

:    •     L'h'          -'.-•••:'  a   l'<iij  •.  .-I     '•  •.•  ;••:•-  :.       !•".  .;•  ;  ;-.-.ik- 

_    .      .•    '  -  •  :.".  •!'   -"!u     far.i       -  '  .'.is    :'.  .< '  1 

:  .  .  „'_'.      Stale 

••,-•.  •  !  \v  1 1  •  i 

:--.  (.'-  in    :!':-..  ur  '•.;•• -i l-:f;i-r. 

'•:..!/.;  :  -jf   v.-.-li  ;.ut:<-re  i 


M   L,.-:ii::t!i  L>  ,•]>:•••>.]  :  .  :'.. '  —  ••  M 
vr-_'.-:;i;.V^  ..-  ._v-  ry  k::.'I.  :.:.  I  v:.:. 

r.u-a.s.      A  !!.«:•••  ;;-.:"  •;•:.;:. ..:•_•  •-:•"••:• 


Th-  >;.'.!-  -I  u-j- •::;':.:.  -:;:v   "\v 
ma::<-r  ••:  ir.":r.t-:,:   \\\::i  i-Mi-ry  :  • 


a.]..:o-I.      Mi'.k  sir,-!.: 


—  t.c  ;u*  n::iy  .:i\r  ;::••  >-r...,  lii 
ii<  ;•;::.  _r  tin.'  !:;:!.•  :-;i".  \v;it-  r. 

<  ';•  \vin-v  may  '•••  !!:::•;••.  :i::«I  a 
i!iLr  '  !:••  11.  !ik  si'.:-  a;,'i  i:.  .  '.k  sr,-'a 

A:,  .:h,-r  ;!;;>;  !.,-\rv:i>i-  \vi::-! 
i'-'fi'  ;•  a  (;--  »r<\  ,:.ari'.v  i!:ai!r  '.  T 
('!'  a-  a  -ii':»;  .;:;;«•  :'t>r  :>  »>.';.  :•-.;;  a 


'-a  a  \  ITY  ;._r^'  •  a:>.i-  • 
li.aiii'.   \v;:;i  a  littit1  '.'fi  >;  "•;•  a:.  .  . 


l:1. t 


MANUAL    OF    IMKTKTICS. 


Then  attain,  a  return  to  nursery  food  is  food  in  the  form  of 
stcsvcd  fruit.  Tin-  toot  hless  j:i\vs  cannot  deal  with  tin-  linn  apple 
as  ean  the  sharp  unblniited  teeth  of  youth,  and  consequently  it. 
niu-t  l>e  liaked  or  stewed:  and  verv  irood  such  fruit  is  for  elderly 
pcrsi  >ns. 

There  is  a  medicinal  niattei-  connected  with  stewed  fruit.  \\  hen 
earn-  suirar  is  added  hv  the  cook  the  resultant  product  is  apt  to  turn 
aeid  in  the  stomach  with  manv  persons  of  middle  aire  and  advanced 
life.  Iii  such  cases  it  is  well  not  to  mask  the  acidity  hv  adding 
commercial  suirar,  bin  to  neutralise  it  hv  an  alkali.  This  leaves  the 
natural  sweetness,  due  to  the  levtilo.-"  suirar  of  the  fruit,  which  is 
Mifito  pronounced  enough  for  elderly  palates.  The  amount  of  bi- 
carbonate of  soda,  to  he  added  when  the  fruit  is  put  into  the 
oven,  is  as  much  as  will  lie  upon  an  Kn<rlish  shilling,  or  a  (Jerman 
mark.  or  an  American  <|uarter  dollar  hit.  to  the  pound  of  fruit. 

This  1-  quite  enough  even  for  unripe  irooscberries.  Such  stewed 
fruit  is  excellent,  and  will  often  a^ree.  where  stewed  fruit  as  ordi- 
narily prepared  (/./'..  by  the  addition  of  cane  or  beet  suirar)  turns 
acid. 

This  matter  will  be  referred  to  a^ain  Avhen  the  dietary  of  the 
u'ont  is  considered,  only  there  it  is  well  to  substitute  the  bicarbonate 
of  pota-h  for  t  he  soda. 

Such  stewed  fruit  with  cream  forms,  or  oujjfht  to  form  a  regular 
staple  in  the  dietary  of  old  a  ire. 

1>\  keeping  the  principles  whidi  should  H'liide  us  in  the  selection 
of  food,  well  in  \  lew.  much  may  In.'  done  to  preserve  the  aired  organ- 
ism in  health.  These  matters  of  mineral  salts,  fruit  salts,  ami  vege- 
table or  meat  salts,  arc  of  much  importance;  and  more  attention 
mav  be  paid  to  them  with  advantage. 

M;lk  puddings  of  all  kinds  and  made  with  Hour,  maixe  llour. 
broken  biscuit,  rice.  saLr'>.  tapioca,  and  semolina  should  form  part  of 
the  dinner,  at  least,  with  all  old  persons.  I'orndire.  or  some  similar 
dish  of  oatmeal,  h^niinv.  or  any  prepared  cereal-  should  alwav-  be  a 
part  of  breakfast.  The  rule  t  hat  all  farinaceous  matters  should  be 
exposed  ton  h;irh  temperature  for  some  time  before  bemv;  used  for 
the  cniik's  purpoM^  .-hoiild  no  more  be  foi'i;-otten  \\-itli  culinary 
preparations  lor  oid  folks,  than  it  should  be  omitted  in  pi-eparin^ 

lllll'SerV    t'ooil. 

The   diirestiye    fei'm-'iits    (like   the    rest    of    thebodv)   are    not    so 

aei  \  c  iii  aire.  ai:d  -o  a      :' 1  -hoiild  be  carefully  prepared:    and  pre- 

di"'ested    r-tarch  is  easily  oiitai liable.      A-  t  here  is  a  ditlieult  y  often    in 


maintainiiiir   tin1    bodv  tern  pc  rat  lire  \\nli   oid    pcop>    ihis    n::i: 
soluble  carbo-hvdrates  must  never  be  forgotten. 

There  is  a  pro-pect  nf  milk  .Miirar  sunn  bein^  placed  upon  -h'- 
market,  and  this  \vill  supplv  a  need  \<>  delicate  children  and  o,d 
people  which  is  \<TV  dcsi  rable.  It  ran  he  added  to  the  miik  and 
mineral  water,  or  be  prepared  MS  a  lemonade,  or  I-M-II  !»•  ;i'M'-il  t»  a 
iin'al  tea.  luU  hcinir  t«(»  s\vccl  to  olTfiid  ilic  [lalatf  wln-n  !ak'-!i 

Slli'll    rnlllpailV. 

\\'ll('ll    chlcrlv    JX'l'SiHH   ilillr    nut     tlli'V    dt'ti'll    flllil    tiM'   cillllrst  ililcS    I't' 

thru-  hosts  ili'tii'iciit  111  condiments  t'i>r  thi-ni.  ai;d  ctuiscijiii-iit  1\  th'-v 
arc  troubled  \vith  llai  ulciicc.  'riic\-  miss  their  \vontcd  i-ariniirati\  ••-. 
••  A  ^'ood  old-!'ashioiicd  plan  of  adding  condiment^  I"  food  without 
otVctid  i  ML;'  the  palate  \vas  lo  make  a  piii  or  two  nf  liiH-ad-criindi  and 
cayenne  [icppcr  at  tahlc;  and,  >o  guarded,  the  rarminativc  worked 
well.  Some  o-u[irinets  used  i<>  carry  a  small  bottle  of  Ncpanl 
pep]ier  with  them  pcrpctuallv.  so  a-  to  lie  prrpared  for  anv  ciner- 
•i'cncv  in  the  wav  of  lack  »\'  flavour inu'  when  dining,  where  mii'-h 
scasoniiiL;'  is  eschewed,"  (The  hiseasesof  Sedeiitarv  and  Advanced 

Life.) 

All  soups  and  all  fish  (except  perhaps  salmon)  arc  suitalilc  food 
for  the  old,  so  are  OVSUTS  and  dams;  hut  lohsters  and  jointed  .-hell 
tish  are  apt  to  disagree,  —  proljuljlv  because  iinpci'fectlv  mastica'cd. 
lleavv  solid  meats  should  be  eschewed  to  a  vreal  extent.  Livjlit 
food  as  chicken,  and  rabbit,  sweetbread,  giblets  and  .-mall  birds  and 
gallic  are  u'ood.  Sheep's  head  well  cooked  is  admirable.  Tripe  •.>,> 
i-  excellent.  Meat  prepared  bv  mincing  or  hasliinu,"  (fiv-h  meal 

beill^   prefci'Mble   to  eold    meat)    is  also   n^ooil.         A    nice   di.-ll    is    prepared 

bv  stewniL;'  some  ha- lied  meat  and  add  in  L:"  a  little  llou  i-\-  potat  oe  \\  :: ;! 
some  pepper  a ud  salt :  which  Drives  vegetable  mailer  as  well  as  annual 
food  in  a  rcadih  digested  form. 

As  the  taste  for  sweet-  does  not  return  with  ap1.  in  the  ca--  oi 
inanv  old  persons  soinelhiliu'  of  the  kind  of  a  rcli-h  is  ile-:ra;  -  •-. 
I'ottcd  meat.-  of  ruanv  kind.-,  beef,  name,  venison,  arc  a; 

/'///c   ili     tn'r    tii'ti^    \<   excel  lent  .    and     111  1  L!' 1 1 1    be    lllorellSed     \\ltll     a-l\ 

tap-      to  say  not  hinji  of   (lieu-ratification    of   the  palate      much  n>. 
than  it   is.     Livers  indeed,  larded  and  roa.-led.  inav  In-  u-ed  f-.-i 
or  cold.      The   Leberwnrsi    of   (icrmaiiN    rich  in  fat    m:v; 
inanv   a    table   and    fiirni-h    a    varielv    of    food    too    mu^n    gflg 
('a\iare    ha-  it-  claim-    to   iifitice.      The    roes   and    n, 
fried  on  toast   mav  lie  1  ried. 

(  h'.-t  cr  .-on  p.  a  red  mil  1  let ,  a  sweet  bread ,  a   part  r,d 


1  :•)!'>  M. \NTA1.    OF    IUKTKTK'S. 

millet,  followed  by  a  digestive  biscuit  and  butter  with  a  trlass  or  two 
of  p-nerous  wine  as  Bucellas  or  Madeira,  would  form  a  '"  company  " 
dinner  for  old  folks,  —  to  which  the  writer  would  have  no  objection 
to  be  invited. 

Or  a  basin   of   whole  beef  tea  with  broken    bi-cuit,  followed    bv  a 
milk  pudding,  forms  a  luncheon  not  to  be  despised. 


cn.vrraj   xr. 

FOOD    IN    AITTK    DISK  ASKS. 

"\\IIKN  life  seems  passing  a\vav  under  their  eves,  the  friends 
will  often  shrink  from  torment  HILT,  as  it  seems  to  them,  tip'  . 
111:111  with  i'oud.  Let  them  not  despair:  nianv  a  one  ha-  recovered 
after  tlif  doctor  has  taken  his  lea\e  with  a  sad  shake  of  the  head, 
and  without  making  a  fresh  appoint nient.  And  let  them  ai-o  he 
stimulated  hy  the  fact —  namely,  that  tin-  pains  of  death  are  a^Ta- 
vated.  if  not  mainly  caused  hy  the  failure  of  the  nutrition.  Kveii 
when  apparentlv  insensihle,  the  living  siill'er  much  increased  distiv-- 
t'rom  want  of  food,  though  thev  cannot  express  their  suiVenn^." 
(  Kin--  ( 'haml>er-. ) 

A  ";ivat  man\'  sick  persons  are  allowed  to  drift  into  a  critical 
condition  when  ill-  from  which  manv  never  railv.  heeaiise  the\  arc 
not  fed — n -it  furnished  with  such  nutrithe  mat'Tiai  a-  their  en- 
t'eehled  powers  can  digest.  That  is  not  a  pleasant  eon>iderati<m. 
either  for  iiiedh'al  men  or  the  hereavcd  relatnes  when  xiine  \alucd 
life  has  closed: 


le'Li'i'et  is  unavailing  when  the  deed  is  done,  and  the  scene  is  eio-cd. 
I)epctid  upon  it.  mvt'iads  of  our  felllow-eivat  uivs  luive  pi-r:-hed 
liecanse  those  around  them  did  not  know  how  to  feed  them:  and 
either  withheld  food  altou'et  her.  or  u'avc  innutritions  food,  under  a 
m  isa  pprehension. 

\\dieiiii  person    is    ill.  the   (litest  ive   organs  are    implicated,  am;. 
prohahly,  the  digest ive   ferments  arc  inipaii'ed,  or  scarcelv  forme. 
all.      To  pour  food   down  tho^nMet    and    to    have    it    assimilati-:!.  :•"<• 
two    totally    dill'erent    tilings   alto-'et  her.      All    that    can    he 
that     the    food    must    lirst    u'o    down    the    gullet",  else    no    • 
po-ihle. 

I.et    us   take  a  person    who  is   laid    prosirate.  say  hy  ';i- 
an    accident,   whei'e  there    is  a    hrokeii    ihi'jh,  while   h';i 
-  nri'-ent .       1  h-i-e  t  here  is  not    I  he  t  hi 


I:)*  MAM'AL  OF  DIETETICS. 

ami  so  there  is  not  the  acute  craving  for  fluids.  The  food  may 
consist  of  (whole)  beef-tea,  \vith  a  little  hroken  hiseuil  in  it,  or  milk, 
or  milk  ami  selt/.er  water;  or  milk-puddings  of  malt  extract,  of 
stewed  fruit  and  cream:  and  later  on.  anv  kind  of  soup.  Then  a 
little  tish.  a  sweet-bread,  or  chicken,  and  so  on  gradually  until  tin.' 
ordinarv  diet  is  ultimately  regained. 

Hut  with  fever  present,  as  in  the  exanthemata,  typhoid  fever,  or 
acute  inflammation  of  the  lungs,  something  more  of  the  nature  of  a. 
drink  is  desirahle.  The  temperature  is  high  and  the  fauces  are  drv, 
and  the  thirst  is  urgent.  Consequently  what  is  wanted  is  1'otus 
Imperialis.  Apple  water,  or  Tamarind  water,  or  Apple  Toast  water, 
or  Apple  Kice  water,  or  the  juice  of  fresh  fruit  as  the  red  currant, 
the  black  currant,  or  the  mulherry,  diluted  with  water;  all  pleasant 
refreshing  drinks;  the  nutritive  value  of  all  being  very  small.  Kice 
water  and  hurley  water  give  something  more  nutritive  than  plain 
water  and  mav  he  flavoured  with  any  of  the  above.  Home-made! 
lemonade  with  a  thin  piece  or  two  of  the  rind  to  u'ive  flavouring  is 
excellent.  Where  cane  sugar  disagrees  it  mav  be  made  with  malt 
extract,  or  Mellin's  Food,  or  if  the  malt  flavour  is  disliked,  with 
milk  sugar  or  levulosc.  Malt  extracts  with  effervescing  water  are 
jjfood.  Thev  supplv  maltose  (grape  sugar),  soluble  dextrine,  some 
soluble  albuminoids  and  some  salts.  Consequently  they  form  an 
admirable  food  in  pvrexial  states.  Then  come  the  meat-infusion?, 
a-  beef  tea  (as  ord inanlv  made),  mutton  broth,  veal  tea.  and  chicken 
broth  and  eel  broth,  all  pleasant  stimulants,  but  lacking  in  food- 
value;  and.  unless  some  baked  flour  be  added,  not  to  be  counted  as 
food,  but  as  pleasant  beverages. 

.Milk  mav  be  u'lven  as  whev.  or  diluted  with  Selt/.er  or  other 
water.  A  'jTeat  matter  to  be  borne  in  mind  with  milk,  especially 
in  the  ease  of  tvphoid  or  enteric  fever,  where  the  bowel  is  weakened 
liv  nleeration.  is  that  it  curdles  as  the  first  step  in  its  digestion. 
When  it  curdles  too  firmly  the  curd  docs  not  fall  to  pieces,  but 
travels  alonur  the  bowel,  a  hard  irritant  mass,  apt  to  lacerate  the 
Weakened  bowel.  This  is  no  imaginary  danger  boi  n  of  apprehen- 
sion hut  a  L.TIIII  fact.  At  the  London  Fever  Hospital  a  glance  is 
alwavs  east  at  the  stools  in  enteric  fever,  and  i 
milk-enrd  arc  .-ecu  in  the  motion,  measures 


consideration.      It  i>    tint    enom.di    to   irive    n     \    ; 

title-;,  judgment    is   also    ivijnired    'o   .-,•,-    th; 
harm. 

1 1  o\v  much  ad  ital  food  is  bein'.:  n'i  ven  with  ;!;• 
(jiiii'kiv  be  pithered  fr-.m  a  glance  over  'In-  nur-- 
LT!\en.  ami  tliis  ii-t  should  alwa\-  In-  <•> <rr>''-\  i\  keui, 

There   arc  other    lluul    finds    which    can    lie    \\~«t]    :..••  ;t   fgHM 
tlicrc  is  uTtiel.  or  oatiiieal   and    water  la  verv  piea-an:  r|f;    k  !.  i*:|  a;.: 
farina  may  lie  u-vd    ami    lie  well    Imiinl  in  \va',er.      A   . 
r-'t-i'Veil    .-uha'-id    fruit  as  Ua<-k  or  rnl    eurraul    jeilv  ma\    \»-   \>«\\< 
\vatcr.aml    on   cuolin^   furnishes  a  |i!ea-ain    chaiiu'e.      A  i.nle   .-u^iu- 
<ir  milk  sii'j-ar  mav  I'c  adileil  ID  -'ive  sunn-  moi'e  i' l-va!ue  in  ill-ink. 

J">\'  n  n^'i  n 'j;  t  lie  < -hull  Lifrs  nil  the  aiinvi'.  ami  L;''\;li'j.'  -'line  'jTai  »•-••, 
or  otluM"  easily  mast  icated  fruit,  when  ;u  .-  ;\-»\i.  all  that  :-  m  d;!iav:'v 
rc'iuireil  is  fiiniishcd  t<i  the  patient.  I:  ;-  Lrraj>e-^u^'ar  thi-  imniia! 

j'nml     of     till'    ln)(l\          \\-llieh     lllUSt     1  i- '    -  1 1  I  1 1  1 1  1 1  •'  i    tUllleet     t  '.  ,  C   U  \  \<  la  t  i"!  i    "  !' 

the  hi  "/I  i  !  en  i  ]  ic  rat  urc. 

]\\  >uitalilii  al;meutati"ii  the  \va-tinu'  ;-  le-s,  and  tlie  patiei  •  d 

ll:it     lie.'nlllc     SO     reduced,    alld     CnllSei  jUellt  1\     llie   !•>  in\  a!''-ei':.  ce    ;-    !!...;•• 

rapid.      \\diere    liccf-tf;i  (as  ordinarily  made)  ;-    -''\'''i    alnne   "'.    tie 
niisapitrclietisinii    that  it   is  a  sustaining  f"nd.  the  >\-;em   ha-  in  e\  -' 

on    its   own    rt'sources,  and    t t'ten    the  patient    sinks    intn  a  ^r:(\-- 

not  dii^'  fnr  him  hv  disease,  hut   h\-  the  ignorance  of   tlm-e  \\  ho  .-nn- 
stitutc  the  nurses   and    attendant-.      Ilui    this  matter    will    he  ta.ki 
of  im  i  re  t'u  llv  furl  her  i  in. 

At    this    pnint   something  mav  he  said    as   to   tin-   as-:milat  i'i'i    <•:' 
food  in  acute  pvrcx.al  conditions.      \\  e  have  --m.d  ri-a~"ii  f'-r  !:".'!  • 
that   tlie  (litest  i\-(>    ferment  -  are   enfechlcd  and    pi'e.-i-nl   hu;    in    -ma. 
(juantitv.      ( 'oliseijiieiit  1  v  \\'e  'j'ive  saccharine  matters  and  lartnacco'i^ 
matters    which    have    lu-eii    preiiiv.-ested    into   a    sn'.uhle    fnrm.      T:: 
relieves   us  of  a  n  \  a  1 1  \  let  v  a  1  »'ii  t  the   saliva    heimj-  innperai :  \  •-.      \\ 
can    furnish  to  the    liody  its  own   fund    proper  (Lrrape--ii--art.   \\,; 
dilliciiltv:    what   is  pert'eetlv  soluble  presents  no   i:  .tli.-n  .•  \  ;   ;md 
foi  nl  t  he  hud V  mu -'    ha \  e. 

l-'at   is  never  rel  ished    hv  t  lie  acute'\    -;.-k .  a  nd 
so  that   it   is  earefullv  skimmed  oil'   the  top  ..;'  ail  meat 
supplied   in  the  milk    which    is    the  |»r-t    atid    ,ea-t    ' 'i 
fat,  and    in  a   hi'_di    state    nf   subd  i\  i-mn.       ll"\\     iar    . 
we  do    nut    k  now.       N '  «i  h;m_r    may  I 

ject. 

The!!    ci.nic-   the    sillijed    of   t  he   a.--:m     a'    "'i     ..'' 


1  }<>  MANUAL    OF    D1KTKTU 'S. 

bumiuoids  for  histogenesis.  This  is  a  dillicult  matter  and  must  be 
judiciously  considered.  1  lippocrates  insisted  upon  nut  rit  ion  in  fevers, 
and  used  harlev  gruel.  Then  came  other  views  until  the  French 
medical  men  went  to  the  other  extreme  and  actually  starved  their 
patients  to  keep  down  the  fever.  Anything  more  abominable  can 
scarcely  he  conceived.  I'mler-feeding  patients  in  febrile  states 
however  continued  till  Dr.  (i  raves  of  Dublin  set  his  fact1  against  the 
plan,  and  insisted  upon  more  alimentation  being  given.  The 
"  feeding  of  fevers"  was  what  he  taught.  This  plan  now  univers- 
ally obtains.  "The  great  art  of  duly  nourishing  fever  patients 
consists  in  giving  a  frequent,  almost  continuous  supply  of  liquid 
nutriment,  containing  very  soluble  aliments  in  a  dilute  form  "—-so 
savs  King  Chambers.  And  now  a  very  unpleasant  task  must  be 
performed,  and  that  is  a  searching  criticism  of  what  the  worthy 
]  )octor  savs  next.  "  The  physician  sees  that  a  large  supply  of  nit  ro- 
genous  material  must  be  wanting.  The  nitrogenous  tissues  are  de- 
vitalised and  drained  away  in  a  disproportionate  excretion  of  urea 
and  other  organic  compound*,  and  nothing  is  taking  their  places. 
Shall  he  act  antagonistically  and  try  to  stop  the  pas-age  of  urea  by 
the  kidnev?  1  do  not  know  exactly  how  he  would  set  about  it:  but 
I  d»>  know  that  if  he  succeeded  he  would  do  positive  harm:  for  the 
worst  cases  of  fever  are  those  in  which  metamorphosis  is  active  (as 
shown  by  the  heat ).  while  the  excretion  of  urea  is  arrested  as  shown 
I  py  the  ligl  it  ness  of  the  urine),  t  hev  resemble  cases  of  unemic  poison- 
ing from  diseased  kidnevs.  The  other  principle  of  treatment  which 
I  noticed  in  my  introductory  lecture  would  not  perhaps  be  so  directly 
injurious,  but  common  sense  would  still  allot  the  palm  to  restora- 
tion here.  Let  it  be  your  chief  aim  to  supply  that  which  is  passing 
awav-  nitrogenous  tissue.''  NOW  the  first  sentence  and  th"  last 
sentence  of  this  quotation  point  unmistakably  to  this,  viz.:  supply- 
in  L;  to  the  body  matter  for  histogenesis,  for  the  repair  of  t  he  wasting 
tissues.  <  in  P  ferring  to  i  he  lecture  from  which  lie  quotes  it  M-CIIIS 
he  advocates  "  I  wo  or  three  ounces  (,f  milk  every  hour."  lie  is  not 
as  lucid  on  this  point  as  he  usually  is.  bin  \ve  mu-t  take  the  state- 
ment as  it  .-land-.  \  ;/..  :  i  hat  I  he  "  chief  aim  is  to  supply  that  which 
you  el  earlv  see  is  pas-ing  a  wav-  nit  roge  nous  t  issue. "  In  the  absence 
df  context  i  hi.-  means  if  the  sentence  moans  am  t  him:  at  all— that 
we  ouirh;  to  supply  nitrogenised  matte!'  to  take  the  place  of  that 
which  is  i  missing  a  \vav. 

Now  to  this  I  demur.      The  tissues  are  melting  down   under  the 
h:i:'h  temperature,  and  the  cancer  to  life  is  that  the  b,ood  is  IM-CUIII- 


in<:  sure  harmed  with   nit  ro^eni-ed  \vaste.  iint:l  a  i-n'i-iitiuM 

("till1     tVpllnid     cond  It  lull  ")     IS    Set     lip.         It     ;>     ll|.'     ;illl«it|  !:! 
AVaste    ill    tlir    IP! 1    Which    is    till'   danger  /•"/'<.«  •'•  .         T'i    hy'.i   ' 

we    trv    t<>    lower    the    tdii]  'era!  11 iv.  1"    reduce    tin-    \\a-tin-j 
:un!    keep    tlir    kidnevs  in   actimi    \<>  ^c\   rid    of   thr   ••\i-iiii!i:i"i    '  » 
tn\ir    matters.       Now  to   ".'ive   ample   supplies   nf    iiit  i-i  >_:'•!!>;:  -•    ','•><>: 
to    iiifft    tin1   \vastr   ^'OIIIL:'   mi.   i-    a   distinct  Iv   dan^erm;.-    i  <\-;i<  •'.,-,..    • 
appears   to    me,  as  tending   t»    increase  tin-   amount    of    nit  r<  >_'<•:,.-..•,; 
matter    nf  cxcrcint'iuitious   cliarai-tcr   in    tin-   s\stnn.      1 'm. ;:,,•;-   <>: 
retrograde     nu'tamorplKisis    are    not     snielv    l'ni'n;-lieii     from     t  --:;.• 
waste:   1 1  lev  come  also  from  t  lie  ///.</'><•<.,, ^n i/i/ ///•/,./  i  if  < mr  a!  lui  mini  >' > ; 
food,  and  to  ^ive  ample  (|iiaiitities  of  alliliminoids  is  t"  inerea^e  th'- 
evil.      (  >f  course  it   is  possil)le  to  contend    that   th-'Se  pi'ote'.d    maKer- 
are  never  {leptmiised,  and  that    thev  mereh  drift  aloiiir   the   :u;nn-!i- 
tarv  canal    till    thev  reach    the    point    of  exit.      \\\\\    then  \\v  an-   nn- 
certain  that  sncli  is  the  case.      Certainly  if   peptuni-ed  fund  In-  -"i'.e:i 
th.cre  is  no  such  escape.      If  pi-ptonc-  reach  ihe  !i\cr  :•   ma\  ; 
tmned,  and   pertilielitlv  (picsl  i<>ned.  if   the  li\er     at  a  hi^h  teni!"':-a- 
ture-  -can    curry   on    metaliolism    and    comci't    any    of    ihc    pri.ti--' 
matter   conveyed    to    it    into   serum-alluimen    I'm'    t;--ne    repair.       A 
downward    career   into   krealin.    kreatinine,   letiein.  ivrn-iti   and    the 
other    products    of    rei  ro^rade    metamorphosis   (some    «i    winch    arc 
toxic)    seems    inlinitelv    more    proliaMc.       To    p'i\i-   ail'iiminoid-    or 
tissue-food    in   amjilc  (plant it  l'es  for   !n-t<  >-vnc~;>  during  pyrexia  1>.   I 
opine,  a  mistake.      \Ve  cannot  lie  certain  al>out   it;    l.ut  to  mv  min 
it  is  ail   1 ,011 1 1  ia  I'd  Si  reel  to  a  ( 'lima  oraiiLi'c  that   in -lead  of  eiicmiraL.r- 
mur  histou'ciicsis  we  onlv  increase  the  risk  "i    nra  ni;a.  or  the  typhoid 
condii  ion. 

It  is  a  matter  which   cannot    lie  demonstrated :    it   niii-t   reman;  a 
matter  of   opinion  and  conjecture  —at  lea.-l    in    the  prcM-nt    slate 
on r  kno\vlcdM'e. 

(  l-'rmu  some  nliservat  inns  made  li\-  I  >r.  (»rd  and    I  >r.   Itroadl'.'- 
the  i.pei  i  in--  meet  MIL;'  of  the  Medical  Snciety  of  I  .«\  t,\,.\  \.  (),-•,,;,,.,• 
!>>.").   it    \vonld    appear    that    there    i-   a    certain    a  ];'M'J«'I  :-m    ' 
histoLi'enesis  and    pvrexia.      \\here    h  i~ii>--ri;c- 
lo\\-ered  teinpei'atnre.      This  alisoi'|it  mn  i  if  hca'  i-  ai'i'e-i  •  • ;    • 
and  the  heat   lost   in  hist  o;j.'eiiesis  is  added  !othchc;^:  ol 
processe-;;   and  sn  swells  the  [ivrexia.      The  lirill   oi   ;h  - 
is    no    histo^enesis    Li'oinu'   nn    in    pvrexia.   \\here   an 

process    is   oil    fool.         TllC  subject     isolieuh.cii    \\  ; , 

m\  c-l  ii;'at  ion. ) 


14'J  MAM'AI-    OK    IHKTKTK'S. 

I'rohablv  1'r.  C'hambcrs  lias  failed  to  express  himself  elearlv:  for 
all  the  men  with  whom  I  have  interchanged  ideas  on  the  suhjeet  see 
il  in  l  lie  liirht  in  which  it  is  put  here.  It  is  now  widelv  recognised 
that  the  estimation  of  the  hulk  of  urea  passed  in  pvrcxial  states — 
once  regarded  as  so  important  —  is  fallacious:  because  there  exists 
no  means  of  telling  which  of  the  urea  is  tissue-waste,  and  what  pro- 
portion of  it  is  derived  directly  from  the  nitro^eniscd  elements  o|' 
the  food  which  have  never  passed  through  the  sta^'e  of  tissue. 

Of  the  importance  of  "  feed  in  ^  fevers"  no  one  no\v  entertains 
any  doubt;  but  of  the  desirabihtv  of  larger  ipiantities  of  albuminoid 
matter  in  pyrexia  the  gravest  doubts  mav  honestly  he  held  and 
expressed.  \Ve  know  that  the  muscular  struct  lire  wastes  and  breaks 
down  into  </<'f>ri*  in  pyrexia;  we  know  that  subsequent  repair  takes 
place  by  thi;  development  of  voting  fusiform  fibres  wit  Inn  the  sar- 
colemna:  but  this  last  is  a  matter  of  convalescence  when  the  appet  ite 
is  keen,  especially  for  animal  food.  There  is  the  pulling  down  of 
an  existing  building,  and  the  erection  of  anew  one  on  the  same 
ground:  but  the  pulling  down  precedes  the  buildiiiLf  up— the  t\vo 
cannot  u'o  on  together  side  by  side  at  the  same  time.  Ilistolvsis 
and  histo^enesis  <,ro  together  in  health  where  balance  rules.  \Vheu 
the  normal  processes  are  perturbed,  upset  by  pyrexia,  histolvsis  is 
augmented,  to  be  followed  in  turn  bv  rapid  hi  Slovenes  is.  Hut  I 
maintain,  a  rapid  histolvsis  is  not  accompanied  but  followed  bv  a 
swift  histo^enesis.  or  tissue-repair.  It  is  the  difference  of  a  pair  of 
Imr-es  side  bv  side  and  tandem. 

It  is  well  for  the  reader  to  determine  in  his  own  mind  what  aro 
the  facts-  -or  perhaps  rather  the  probabilities  of  the  facts — other- 
wise in  well-meant  endeavours  to  do  the  fever-stricken  patient 
Lroml  \\  e  mav  be  but  reducing  the  chance  of  survival:  and  but  add- 
HILT  fuel  to  llame.  bv  .-til!  further  ladintr  the  blood  with  nitrovvnised 
waste. 

i  >r  .lames  II.  Dennett  has  something  to  sav  about  ''Defective 
N  til  rit  ion  from  t  he  Ivxistenee  of  Acute  I  (isease."  to  t  his  elVecl  -  -"  In 
acut"  disease  the  functions  of  nutrition  are  partiallv  suspended,  the 
digestive  powers  are  weakened,  or  even  for  a  time  arrested:  hence 
the  lo.-s  of  appetite,  or  even  the  absolute  loatliini:  of  food  which 
ensues.  The  digestive  orLfans  beiiiLT  unable  to  transform  and  elabo- 
rate food,  an  all-wise  I'l-ovideiiee  preserves  them  from  the  labour 
tliev  are  iiiii'ijiial  to  perform,  bv  dest  roving;'  the  desire  for  nutri- 
ment, and  rapid  emaciation  I M] lows,  the  more  ra]>id  the  more  eom - 
piete  the  iiiabilitv  to  digest  fooil.  'I'he  process  of  organic  destruo 


tion  or  disintegration    inseparahle  from    tin-  use   «\    our  u :••_': r  - 
it-eif  a  condition  of  life  noes  on.  accelerated  perhap-  hv   •:.- 
hut  tin1   material  ti)  repair  the  loss  not   Iteiiiir  all'»rded  io  {]•.*•>  «  _ 
satioii    it   wastes   in  voiunie.      Moreover,  as  the  material-  <>:'  ":_.. 
comhii-tion    foi-   the  generation    of    heat    are    not    elaborated 
digestive   organs,  t lie  eeoiiomv  isohh^ed    to    re-ahsorh  and    eon--; 
its  own    fat.    -deposited,   no    douht.    ill    its    cellular    ti-Mlc  partly  a-  ; 
kind  of   reserve  tissue.      Thus  it  is  that  after  an  acute  iSlne  —  of   two 
or  three  weeks  the  emaciation  is  .-ometnnes  extreme,  more  e-pe,  .a.lv 
when  from    tin-    nature   of   the  illne-s  it  has  Keen  impossihie    for   the 
patient  to  digest  any  kind  of  food. 

"  In  continued  fevers,  in  which  the  iliahiiitv  to  take  and  dLre-t 
food  is  all  hut  complete,  and  which  mav  last  for  weeks,  it  i-of'en 
found  alisoluteiv  necessary  to  <,ri  ve  win;-,  or  other  alcoholic  !K-\  erases, 
in  order  to  alYonl  to  the  organisation  the  i-lements  t'oi1  heal-'_r|>iiera- 
t  ion.  or  organic  comhust  ion.  and  to  retard  the  process  of  de.-tnic- 
tive  metamorphosis  of  tissue.  In  the  ahsence  of  -m-h  aid.  the 
extremities  and  then  the  l)ody  <n;nidualiv  heeome  colder  until  deatii 
ensues,  as  much  from  cold  as  starvat  ion.  In  th;-  case  ihe  human 
lire  sini])lv  p>es  out  for  want  of  fuel:  like  a  coal  or  wood  lire  li, at 
lias  exhausted  all  the  materials  of  whieh  it  is  compo-dl.  and  which 
expires  for  want  of  their  renewal." 

But  ;lll  uIoiiLT  it  is  "  fuel-  food  "  not  "tissue-food"  for  which  hr. 
lieiiiict;  <'ontends  so  eloquently,  and  what  >s  aliout  to  he  said  is  a 
content  ion  on  the  same  lines. 

Imperfect  supplies  of  "  fuel-food  "  to  the  wastint:  organism  have 
the  effect    of   permitting:  u'l'cat    emaciation,  which  more   iiheral   sup- 
plies   would    prevent:    and    on    the    present    plan    of    treating  acute 
pvrexial   maladies  we  eertainlv  do    not    prevent    \va.-tiniT.  and    uilh  ;t 
coiiseouent  lal    weakness,   as    we    mi^'hi.       ISccf    tea    (howevci'    made) 
contains  practica'lv  no    fuel    food,  while    milk    contains    hut    a    com- 
parative! v  small  pro  port  ion  of  rnilk-su°;ar.     (  'on-i'ipient  Iv  our  i  -a;  .<••. 
are   apt    to   dit — a-   thev   did    under   the   l-'reneh    ph\>ic;an-  who  •:•• 
[irived    them  of  all    food  and  called  the  stai'vali'Hi  |'ian  '/ 
opeiilv  <tarv  ed  them  to  deal  h :    while  we  allow  them  to  die  hv  '_i\  :n-_ 
them    in-ulTp'ient    food.      The  dilTereiice  onh   lie-  in  the,         \~\i\  <>:' 
the    Krenehnieti.        \\  e    stand    hv    the    d\  .  ni;'    patient's 
hevvail  t  he  failing   strength,  talk    ^ravelv  of    i  he  t  hreale'i.'.u"  ,-\ 
t  ion    of   the  power-     and  do  nothing  t"  pre\eii!   the   o:, 
e\  ha  i  i  -I  ,  on.       \\  c  see  the  wa.-t  mi;'  L:'OI  ][•_;•  in.,  and    la  men 
we  do  lit ;  le.  or  nut  hini:.      \\'e  leave  t  he  pa:  j  :.;  \<j  - 


144  MANUAL    OK    PIKTKTK'S. 

;uul    unaided.      \\  e  certainly  inve  some  alcohol — a  rciulilv  oxidisable 

fuel-food-  hut  we  do  not  act  efficiently.  If  the  subject  of  cxhaus- 
tion  were  only  more  fully  and  completely  considered,  we  would 
know  how  to  hel j)  and  succour  t he  sinking  organism.  At  the  recent, 
annual  meeting  of  the  British  Medical  Associat  ion  at  CardilT  ( 1».V) 
I  read  a  paper  entitled  "When  a-  Patient  dies  of  Kx'huustion  what 
does,  he  die  of  ?  "  lie  d  les  hecaiise  his  bod  V-storo  of  fuel  is  exhausted  ; 
because  we  do  not  supply  to  him  the  j^rape-su^ar  which  is  the  normal 
lioiiy-fuel.  and  his  rcserye  stores  of  fat  cannot  he  trot  at  sufficiently 
rapidly.  \Vestarveour  patients  into  exhaust  ion.  ami  bemoan  the 
fact:  and  then  lca\'e  them  to  their  fate,  without  doini;  anything  to 
sayc  t  hem  from  it. 

It  is  a  irravo  and  serious  charge  to  hrin^  against  ourselves,  and 
the  matter,  as  the  President  of  the  Medicine  Section  (S.  Wilk-)  ob- 
served, the  matter  is  one  of  the  very  pv.itest  importance.  I  >o  we, 
or  do  we  not  allow  our  patients  to  die  from  insufficient  feeding? 
\ot  one  person  present  at  the  reading  of  the  paper  disputed  my  pro- 
position. It  is  true  then  that  we  do  not  feed  our  sinking  patients  as 
we  should.  \\  e  oiiLi'ht  to  supply  to  them  ^rape-siiLi'ar  in  free  quan- 
tit  ics  in  order  to  conserve  and  economise  t  he  body  stores.  'The  becf- 
tea  ouirht  to  contain  well-baked  flour  (much  of  it  soluble  dextrine), 
or  even  milk-suirar  or  maltose,  which  is  not  too  sweet  for  most 
palates.  We  should  irive  lemonade  made  with  milk-suufar.  or  le\  u- 
lose.  Acidulated  drinks  wit  h  uTapc-supir.  or  its  equivalent  ouirht 
to  be  'jivcii.  Water  is  wanted  to  allay  thirst,  and  drinks  should  lie 
so  made  as  to  have,  a  distinct  "food-value."'  If  the  patient  cannot 
take  such  drinks  and  will  only  drink  water,  then  of  course  we  are 
not  to  blame.  But  when  the  patient  docs  not  p't  the  chance  of 
such  nutritive  drinks  then  that  patient  is  a  victim  to  ignorance-  a 
sacrifice  .-imply.  It  is  not  a  matter  for  demonstration,  it  is  one 
which  reason  can  determine:  and  if  after  this  outspoken  protest  any 
reader  of  ihi-  work  does  not  feed  his  patient  properly  by  the  li^ht 
of  science  he  is  a  murderer!  There  are  sin-;  of  omission  as  well  as 
Kins  of  commission,  and  to  allow  a  poor  patient  to  die  unfed,  is  like 
allowing  a  man  falling  overboard  to  perish  by  not  throwing  him  a 
life-buoy,  or  a  rope— when  those  are  ready  to  hand.  \\hat  should 
we  say  in  thi-  la-t  case  which  would  not  apply  to  the  lirst  ?  Of 
course  --o  loni:  as  \\"edid  not  kno\v  wha;  it  was  the  sulVerer  needed 
there  was  no  blood-LHiilt iness.  So  loni;-  as  the  dill'erent  form-  of 
LTape-siiLfar  were  not  to  hand  we  were  nol  blameworthy.  I5u:  now 
that  we  know  what  is  required,  and,  further,  have  the  materials  to 


liaii'l  tin-re  is  no  palliation   of   theolTcr.ce:    no  rv-u--.' !      A 

tin'  outcomes   cf   svstemat  \<-   lecture-   on    dietetics   oiii/h:    •••   '••• 

proper  and  ct'iicien!  feeding  of  put ieuts  in  aeuie  di-ea~e.  and  -i  »•••;;,;  •, 

in   pvrexia!    maladies:    so  that    thev  .-hall    not    hceume  wa-'i-d  .•.••  ;  ,-\ 

hail-ted      further  than  we    ran    pos.-ihlv    he!n.       "  Knuwlcd; 

luit   wisdom  lingers"  and  now  that   we  realise  the  importune.-  uf  - 

plviiiLT  u"rapc-stiv;ar  to  tip'  ecuiiomv  in   its  dav  of  trial.   we  ean   !•'•',:••'• 

etlicient,  ai'l  tothesiek  man    halt  !;::•_:'  wit  h   ilisi-ase,  ami    sueciiiiih:1: 

to  oxhuustion  if  \vc-  do  nut   intei-fere. 

\\'liat    \vas    written    !iv  !\.iii^  ( 'liamhei's  and    (pioted    at    th--  cnin 
nienceiiimt    of   this   cha|iter   should    hnrn    itself   into   every   reader's 
niemorv,  \i/..:    that   inanv  sick    persons   pass   into   a    i-ritieal    ^-la:;'1 
fruin  whiidi  inanv  never  rallv      heeause  thev  are  insnlTieieiit  Iv  fed. 

\\hat  was  the  denuiu-iat ion  on  tho-e  \\dio  »'ave  no  fum!  to  the 
hunu'ry.  no  drink  to  the  thirsty?  "  hepart  tVom  me.  ve  enr.-e  i. 
into  everlas!  MIL:'  lire."  Aiu!  everv  man  who  has  allowed  a  pa  tie!.! 
to  die  of  exhaustion  without  havini:'  maiie  a  stout  iMii  fur  him. 
deserves  like  (  'a in  to  carry  the  hraml  of  murder  un  him  fui'  t  ;>•  re-i 
of  h.is  days. 

1-lveii  wlieti  the  loathing  for  fond  is  pronontieed,  it  stiil  remains 
possdile  to  ad  m  mister  em -ma!  a  of  ^rape-suirai1  \\  it  h  meat  lirot  hs  eon- 
tiiininjj  salts  and  the  stimulant  extractives  uf  meal,  or  when  the 
typhoid  condition  is  pronounced  ,--iieh  feeding  nuu'ht  stdl  !»•  e.ei- 
tinued.  The  patient  must  lie  supported  in  the  hour  of  trial;  and 
if  this  he  proper! \-  done  we  mav  fairlv  expect  a  Li'ood  pcrccntai;'1'  of 
case-  to  rallv  which  now  u'o  on  from  had  to  worse  till  death  !>v  ex- 
haust ion  closes  t  he  set-lie. 

I  now  add  the  hictaries  in  use  at  the  London  Kevcr  Hospital, 
from  which  it  is  clear  that  the  patients  there  are  not  starved  hut 
have  ample  allowances  uf  food  provided  for  them. 

The  whole  snhjeet  of  the  feed Mi'_;- of  persons  acutclv  ill  and  ::• 
critical  conditions  is  one  un  whieh  some  histruct  ion  is  desirahlc. 
Milk  does  not  aii'i'ee  with  all.  Iiecf  tea  is  a  stimulant  and  not  a 
food.  What  the  patient  needs  is  soluhle  carho-hvdrates,  whi'-h  can 
he  ^'iven  in  vai'iou-  forms,  which  arc  not  particularly  expens;\e. 
\\'hat  the  hu.-tur  wants  is  information  on  the  stihject  uf  t'efdini:'-. 
And  if  the  K'oval  ('ulle^e  of  IMtvsicians  of  London  could  for  um-e 
its  historv  put  it-  hand  to  a  ii-eful  work  and  ^ive  the  wor.d  -o".,.- 
evidence  uf  ns  ntiliiv.  some  cxeu-e  for  us  existence,  m-tcad  o; 


14-»)  MANUAL   OF   DIETETICS. 

it  seems  the  fittest  liod v  to  undertake  such  ;i  \vork.  If  it  would 
onlv  have  one  <|iie>tion  on  Dietetics  in  its  examination  for  the 
superior  qualifications;  of  its  Membership  it  would  lie  hiking  a,  step 

in  the  riu'ht  direction.* 


•''  From  a  nmnlier  of  experiments  jtci'fonni'd  of  rcc-dit  ynirs  it  si'dus  Hint 
thi'  dit^vst  ive  tin  ids  and  their  several  ferments  uro  gravely  impaired  in  acute 
disease.  This  Uiet  adds  stivnyth  to  the  views  advocated  in  this  chapter. 


CHAPTER    XVI. 

FOOD    IN    COXVALKSCKNCK. 

''  Ix  the  management  of  convalescence  tin-  patient  should  never 
he  permitted  to  sit  out  of  hed  till  the  .-t  ren^t  h  In-  consideruhlv  ad- 
vanced. It  is  hetter  that  iv.-t  rift  ion  -hould  lie  imposed  a  little  too 
loni;-  than  that  rtnv  risk  of  relapse  should  he  run. 

'  The  next  point  is  of  still  <rivater  consequence  i  he  proper  regu- 
lation of  the  diet.  In  our  experience.  hv  fa  i-  the  ^reater  uumher  of 
cases  of  relapse  take  phiee  from  indiseretion  in  diet.  It  should  al.-o 
lie  st  roiiLi'lv  impressed  on  the  convalescent  that  il  is  us  iieecssirv  t» 
LTuard  against  the  quantity  as  the  qualitv  of  food,  particular,  v  when 
tliere  has  hcen  irastrie  irritation  in  the  progress  of  the  fever.  Tiie 
stomach  mav  he  al>le  to  digest  and  assinnlate  a  limited  proportion  of 
food,  hut  the  indulgence  of  an  extra  ounce  or  i  \vo  mav  induce  op- 
pression and  a  renewal  of  the  fever.  This  or^an  in  convalescence 
partakes  of  the  external  mu.-cular  dehilitv.  and  the  convalescent 
mav  as  well  expect  to  he  ahle  to  carrv  a  lieavv  load  on  hi.-  shoulder-. 
as  to  diu'e^t  an  undue  fjiuuititv  of  food,  even  of  a  suitahle  kind." 
(Tweedie,  Article  ''  Fevi'i1  "  in  the  Cyclopedia  of  Practical  Medi- 
cine. ) 

When  the  worst  is  over,  and  the  critical  period  passed,  the  pros- 
tration is  liTeat.  Care  in  the  administration  of  food  and  the  e\h;h;- 
tion  of  stimulants  is  still  required.  lint  shortly  the  sorde<  d;- 
appear  from  the  teeth  and  lips,  the  hrown  fur  dears  oil'  the  surface 
of  I  he  tongue,  and  with  these  comes  some  return  of  the  appetMe, 
and  a  relish  for  food.  The  weakened  condition  of  the  organism, 
hot  h  in  its  whole  and  in  each  component  part,  must  he  home  ,n 
mind:  and  in  all  illness  and  dehilitv  the  .-tfiuaeh  is  invol\ed.  and 
is  functionally  impaired;  in  other  word-,  all  .-ick  and  weak  p  T-on- 
are  dyspeptics.-  and  must  he  fed  accordingly.  Small  ipianni 
milk  and  seltzer  water,  of  whole  heef  tea,  of  meat  infusion-  with 
sohihle  carl)o-h\'dratc-  are  rcijiiired  at  freqiieiil  inter\a',-. 

And  there  is  one  point  to  he  attended  to  HI  the  feeding  of  early 
convale-eence.  and  that  is,  not  to  rai-e  the  patienl  up  a!'rup:'\  in 
order  to  lie  feil.  The  heart  >tructure  is  exteti>ivelv  -i  !-op_ya:i  -  hv 


Hs  UAM'AL    OF    l)li-:TKTR'S. 

acute  and  still  more  l>y  sustained  pyrexia.  and  a  great  many  of  the 
muscular  bundles  are  reduced  to  a  mass  of  ili'hri*  in  the  histolytic 
process  which  has  gone  on,  so  that  the  heart-\vall  is  weak,  and  to 
raise  the  patient  suddenly  is  to  throw  the  weight  of  the  blood- 
column  in  the  head  and  neck  abruptly  upon  the  heart.  Under 
these  circumstances  the  left  ventricle' is  unable  to  bear  the  weight 
so  thrown  upon  it.  and  comes  to  a  standstill  in  diastoit — flaccid  and 
distended  with  blood.  Kven  after  the  patient  has  recovered  suHi- 
ciently  to  walk  about  the  room  this  danger  of  heart  failure  is  not 
fully  past;  and  after  the  high  pyrcxia  of  relapsing,  or  famine  fever, 
it  is  not  unusual  for  the  convalescent  to  drop  suddenly  to  rise  no 
more ---the  weakened  heart  having  stopped  abruptly.* 

The  appetite  for  food  steadily  increases,  and  must  be  met.  Small 
quantities  of  milk  puddings  of  very  digestible  character  may  be  Driven: 
such  as  those  made  with  broken  biscuit,  or  with  shredded  mai/e, 
or  cooked  hominy,  or  jndeed  any  farinaceous  matter  which  has  been 
already  exposed  to  a  high  temperature.  Mi'k  or  cream  with  cold 
cotl'ee  forms  an  admirable  nutritive  beverage.  There  is  often  a  con- 
siderable amount  of  thirst  lingering,  and  this  calls  for  beverages, 
which  can  easily  have  a  food  value  given  them  either  by  some  form 
of  maltose  or  grape  sugar,  or  by  adding  some  baked  cereal,  (iniel 
made  with  baked  flour,  or  baked  oatmeal  is  -rood.  The  lactated 
foods  can  be  used,  and  if  need  be.  may  he  flavoured  by  red  wine  of 
any  kind,  or  by  some  other  flavouring  a^ent.  Lemon  juice  SULTU'C-LS 
itself  as  a  pleasant  acid  assuaging  thirst  effectually.  Sairo  and  rice 
milk  mav  be  added,  and  oatmeal  and  hominy  porridge  make  a 
change.  Blancmanges  suggest  themselves,  but  should  not  be  made 
of  raw  or  uncooked  starch.  The  salivary  glands'still  feel  the  storm 
which  has  s\vept  over  the  organism,  and  have  not  regained  their 
capacity  to  digest  starch.  To  forget  the  fact  is  to  run  the  risk  of 
filling  the  enfeebled  stomach  with  undigested  starch — just  about  the 
most  effectual  means  of  upsetting  it  that  could  be  devised.  |)r. 
Tweedie  warns  us  against  errors  in  alimentation  in  convalescence, 
and  this  is  one  of  the  most  common.  A  little  later  on.  an  overload 
or  surfeit  is  apt  to  occur  from  the  appetite  being  too  keen,  and  the 
quantity  taken  at  on>-e  too  much  for  the  stomach.  A  greedy  feeder 
is  most  liable  to  this  last  risk  of  relapse;  hut  all  convalescents  mav 
experience  a  "  back-cast  "  from  a  quantity  of  undigested  starch  find- 
in  L:  it-  wav  into  t  lie  stomach. 

Then  the  patient  advances  to  some  white  fish  boiled,  to  a  sweet- 
bread, to  some  chicken.  It  ;s  nut  necessarx  to  tempt  the  appetite 


liv   condiments,  the    palate   declares    fur   simply   div-sed    !' i.      Ti. 

]il:iiner  the  food  the  hetter.  The  palate  ivipiiivs  no  tick^n^  01- 
St  lllllliat  HILT:  tile  desire  for  food  is  kecll.  and  eU^er  enough  to  do 

without  any  whetting.  It  i>  no;  like  the  invalid's  ea.-e  where  ;he 
:i|i|tetite  is  small  and  fastidious.  ^  oiiir^  convalescents  from  acute 
disease,  can  generally  eat  anv  t  hini:  oiTetvd  to  t  hem  ;  and  consequent  '.v 
those  in  attendance  upon  them  should  exercise  jud^im-ia  in  the 
selection  of  the  viands  supplied  to  them.  Thev  eat  and  Lro  to  >'.ecp. 
— to  waken  up  with  a  craving  appetite. 

Tliere  has  been  a  severe  demand  upon  tlie  ho.lv  stores  of  ;'no,l 
which  have  to  he  huilt  up  apiin.  Tliere  has  heeii  extensive  dest  in; ••- 
lion  of  the  nuisenlar  tissues  hv  a  rapid  histolysis,— tlic  tissues  melt- 
ing do\vn  rapidly  under  a  lu^li  temperature.  Ad  this  has  \<>  be  met 
and  repaired;  and  the  appetite  is  keen.  and  the  digestion  active  mid 
rapid.  Nevertheless  it  is  \ved  to  c(imm;t  no  error:  as  all  persons 
familiar  with  disease  and  convalescence  know  thai  a  relapse  is  fol- 
lowed by  a  slower  rale  of  repair.  Once  a  "hack-east."  and  the 

pr 'ss   of    repair   and    the    progress    .if    the    convalescent    are  a'.ike 

slowed.  A  maxim  with  Sir  I'Yederiek  Kolici'ts  in  liis  A t'L.rlian  experi- 
ence was.  "  \\  hen  voti  have  once  ^ot  an  OriiMital  on  the  run.  keep 
him  on  the  run."  If  his  Ili^ht  was  not  kept  up  he  mi^'hi  rot  -ome- 
where  where  it  ini^ht  not  be  so  easy  to  dislodge  him:  consei|iient  ;v. 
it  was  best  to  keep  him  ^'oin^'.  So  it  is  \\itli  convalescence,  u  is 
best  unbi-oken  and  uninterrupted.  Once  a  check,  and  the  onward 
progress  has  apun  to  be  initiated.  And  all  initial  movement  is  >.ou 
even  in  a  (ireat  Northern  I1! x press.  I-ivei'v  stop  involves  a  I're-li 
start.  ( 'arefullv  t  hen.  and  wit  h  cant  ion  1  iberal  supplies  of  fond  ma  v 
be  ^'iveii  ID  the  convalescent.  \\\\\  it  must  be  borne  in  mind  there 
ai'e  convalescents-  -and  convalescents.  Tnerc  is  the  robust  hardv 
vouth  who  has  had  a  .-mart  attack  of  enteric  fever:  as  soon  a~  h.- 
ap[ietitc  I'eturns  he  can  eat  anvt  IIIUL:'.  a  -heep  in  its  wool  aliuo-;. 
lint  there  is  too.  a  delicate  u'lrl  recovering  slowlv  from  an  atlack  of 
scarlatina,  witli  kidncv  complication-.  She  is  a  very  ditlefenl  eo;i- 
va  icscent  :  t  here  is  t  he  in  jurv  done  to  t  he  kiilnevs  to  be  kepi  in  .-.•_;  ii  I , 
and  never  forgot  ten.  The  kidneys  are  a  'j'real  factor  ;n  t  he  ehniina- 
tioti  of  nitro^eni-ed  waste.  \Vliilethcyarestill  I'cehiiL:'  the  ejects 
of  the  disease  which  has  pa-.-ed  over  them,  thev  are  not  e<jua.  to 
^•feat  demands  upon  them:  and  this  t'uiiet  ioiial  deluliiv  iiiu-t  : 
overlooked  or  even  underestimated.  Small  ipiantit  -  oi  a:.;mal 
food  alone  are  safe  here.  The  hunirrv  vouth  who  IM  n  .-caive,  \ 
til!  the  sheep  is  skinned  wouM  be  tort  ui'ed  and  injured  ;.\  ;;:, 


K.I  i  MANUAL   OK    IMKTKTK'S. 

meals,  sparingly  composed  of  animal  food,  which  would  be  proper 
in  ilif  other  cast1,  -wlulr  alinu'iit  suitable  enough  for  him  would 
lie  fatal  t<>  tin-  Li'irl  in  ail  probability.  "  \\'liat  is  one  man's  food  is 
an<  i;  her  man's  poison.  " 

The  importance  of  bearing  in  mind  the  function  of  the  kidneys 
in  the  dietetics  of  convalescence  is  illustrated  l>v  the  following  ease, 
lu  mv  earlv  davs  of  village  practice  in  \Vestmoreland,  a  case  of 
nephritis  camo  under  my  care. — a  typical  case  of  acute  Urip'ht's 
disease,  not  post -scarlatinal.  l>v  suitable  measures  convalescence 
was  secured.  1  \vashutayounir  practitioner,  and  though  the  case 
was  doinir  well  somebody  thought  it  might  he  doing  better.  So  an 
older  man  was  called  in.  who  thought  I  might  allow  some  more  food 
and  administer  some  steel.  Accord inglv.  this  was  done,  and  for  a 
day  or  two  all  went  well.  Then  came  a  change  sudden  and  rapid:  in 
spite  of  nil  that  could  he  done  uraMiiia  set  in.  and  the  girl  perished. 
That  case  has  been  one  corner-stone  in  the  building  of  my  medical 
experience.  Itegret  was  unavailing:  and  I  went  on  a  sadder  but  a 
wiser  man. 

In  like  manner  after  enteric  fever  it  is  well  to  remember  that 
there  has  been  ulceration  of  the  bowels,  often  extensive,  sometimes 
deep,  and  t  hat  hard  pieces  of  food — as  unripe  apple,  or  insufficiently 

< ked    potato—  nii^lit   readily  cause  a   perforation   of  the   weakened 

lio\vel.  My  repertoire  contains  no  warniuir  case  telling  of  forgetful- 
ness  he'v.  which  could  be  placed  at  the  reader's  service.  A  medical 
experience  involves  a  certain  element  of  patients  sent  to  their  doom 
by  Slime  sin  of  omission  or  of  commission,  and  mine  is  no  exception. 

l>ut  in v  experience  can  tell  of  a  verv  instructive  case  anent  con- 
valesceuce;  and  the  recital  mav  help  some  reader  in  a  difficulty.  In 
my  earlv  davs  an  old  peasant  woman  was  ser/.ed  with  complete  sup- 
pression of  urine.  She  was  a  hale  old  dame,  and  after  three  days  or 
so  of  active  treatment,  the  urine  reappeared.  Of  course  a  careful 
examination  of  it  was  made,  and  sonic  tube-casts  were  found.  Tak- 
ing what  Sir  Thomas  Watson  said  about  tube-casts  as  my  guide.  I 
nave  it  as  mv  opinion  the  old  crone  would  not  long  survive  the 
attack.  Tin-  coining  t,,  ]|,.j-  (.:ir-  made  her  verv  wroth,  and  she  at 
ouce  transferred  her  professional  confidence  to  an  irregular  practi- 
tioner in  the  neighbourhood.-  -who  was  always  in  demand  whenever 
the  regular  practitiniier's  opinion  was  unfavourable,  or  }\\<  advice 
distasteful.  Hi-  opinion  was  thai  she  onlv  wanted  something  to 
cat  and  drink,  and  she  would  do  well.  This  jidvice  was  promptly 
followed,  and  carried  out  with  the  most  satisfactorv  results  to  the 


patient.      Sin'   glowered   at    me  with    e\i!    eve,  whi-M. ••..•••  I  huiM»-' 
1"  ride  past  her  cottage.  :md  held  tin-  poorest   p.. --;!,;,•  opinion  ,,•'  •  ..-. 
professional  capacity.      And  well  -hcmi:_rht.  for  ei^ht'-.-n    \.-ar-    :  IT.- 
passed  aii'i  'jri'iic  since  then,  and  sin-  -till    li\e-  to  bear  in-r  tc-timonv 
to  ihc  crronei>n<nes-  of  inv  opinion  HI  her  ru-<-. 

A  vcrv  common  cause  of  interruption  i«  the  JH-IILTC--  ;:i  cuii- 
valcscciicc  is  an  excess  of  t'"«i'l.  'rin-rc  is  iHscuml'urt  w:th  a  -harn 
n-c  of  teni|ierat  ure.  sutnet  mies  yi>iiiitiiiir,  coinnmnlv  sunn- j>iir:_r:nLr, 
with  the  i-.-snh  i>f  cleariiiLT  tlie  system.  In  strmiL:  '>rLfan;-ni<  the-^e 
intei'dirrent  ileran<xeinent.<  ]>rn(hice  lit  t  !>•  i>r  n<>  etl'i  •<•;  :  Inn  with  Meli- 
cate  individual-  thev  ai'e  fi'aiiLrht  with  a  certain  risk  t"  !:l'e.  and  tin* 
often  havt  a  very  malignant  etl'ect  upon  tin-  onward  |H'i>i_rres-;  nf  the 
case.  In  tlms"  wh.o  have  l»-cn  Verv  irravclv  ill.  and  in  :h<>-<-  \\h» 
have  any  constitutional  delicacy  m-  special  gastric  intiniiltv  the  \-(-ry 
Create-;!  caii;  must  ))••  tak'-n.  Such  a  case  cam>-  under  niv  notice 
lately.  A  delicate  ^irl  had  a  slight  jiiieunionia  with,  a  ^<»»l  <{>•;{]  «\ 
pa-trie  ii-rita'iilitv.  I!v  very  careful  dieting  she  went  <>n  very  satis- 
i'actorilv  and  seemed  likely  to  weather  the  storm:  luit  ju-t  as  she 
seemed  "out  of  the  wood  "  an  injudicious  meal  inaugurated  a  1'apid 
downward  pi-o^-i-ess. 

Li^'lit  fooil.  as  ehjeken.  ral'liit.  pime.  and  small  hirds  mu-t  pre- 
pare the  wav  for  chop-,  steaks,  and  a  cut  from  the  joint,  together 
with  suitalile  yei^etahles.  The  dietaries  of  the  London  Fever  H.>S- 
pital  mav  be  adopted  until  the  whilom  sick  person  is  out  of  t  he  doc- 
tor'.- hands. 

The  amount  of  food  a  strong  and  previously  hale  vniini:  man  will 
cat  in  a  dav,  after  an  acute  attack  of  fever  is  something  siirprisni^;. 
We  hear  of  ei^'ht  <ir  ten  meal-  a  dav.  and  pretty  i;ood  meals  too, 
he  in  IT  taken  under  such  circumstances.  In  fact,  the  convalescent 
wishes  to  be  back  to  hi-  place  in  the  world  and  to  hi-  work,  and  he 
c\pe(lites  his  progress  thereto  to  the  best  of  his  ability.  I'.u:  thep- 
is  an  old  ada-v  which  says— "  The  more  ha-te  the  less  spec.1,."  a".'; 
solliet  illie-  tin-  i-  t  he  case. 

It  is  not  always  desirable   that    the   plentiful    dietary  of  the  con- 
valescent   be  too  rich  in  albuminoid    material-,      \odoub:  there  !:a- 
bei-n  tissue-waste,  often  extensive,  and    material  is  needed  for 
paii'.      Hut  this  end  is  not  always  served    by  liberal  .-upp'>'- 

sharp  at  lack  of  enteric  fever  in   India,  wrote  to  me  to  ;.  ; 

His  heart  wa- con-iderablv  weakened  l>\  !  he  ',  ;->iie-de-i  i-;;."  ...  M 

ha.|  "'.'lie  oi,  iii    the  pvre\ia:    and    he  made  hi-  \\'a\'  a-  -:"••••          ;.-   in1 
i  . 


l.VJ  MAN  I' A  I.    OF    DIKTKTirs. 

cnuld  t»:i  French  cook,  whom  lie  found  in  Homliay.  Here  he  went 
in  for  liberal  meals  supplemented  by  generous  Burgundy.  Hut  to 
h:s  threat  disappoint nieni  lie  did  not  improve  as  he  had  anticipated. 
On  arrival  at  Aldershott .  lie  found  a  friend  deep  in  the  perusal  of  uiv 
\vork  on  "  Indigestion  and  Hiliousness,"  who  ilrew  his  at  tent  ion  to 
some  remarks  therein.  a<  to  the  dilTerenee  betwixt  meri'lv  swallow- 
ing food  and  its  digestion,  and  the  importance  of  li^'ht  food  where 
the  liver  cannot  deal  with  a  large  quantity  of  proteid  matter.  Ilis 
own  ])lan  having  failed  egrcgiously,  he  determined  to  accept  my 
suiTLTi'^t  ions,  lie  put  himself  upon  farinaceous  food  and  iish—  mat- 
ters his  liver  could  deal  with — forthwith,  and  the  results  were  so 
satisfactory,  that  he  made  my  acquaintance  iu  order  to  report  to  me 
the  (to  him)  wondrous  results. 

Where  the  liver  is  weak  it  is  not  well  to  overload  it  bv  an  ex- 
cess of  albuminoids,  for  the  burden  only  deepens  its  mobility  to 
carry  on  the  metabolism  of  protcids. 


CIT.VITKi:    XVII. 

FOOD    IN    GASTRIC    AFFF(TK>NS. 

IN  this  chapter  it  seems  desirahlc  to  commence  \vii  li  the  .-'. 
forms  of  trouhle.  and  to  proceed,  later  on.  with  the  considerati 
t lie  graver  forms.      Indigestion  will    lie  deal!   with  in  a    later  ch 
at  full  length;    t  hi'  present   eonsiderat  ion    licine;  devoted    in    po- 
d  isea.-e  of   i  he  stomaeli. 

The  mam  maladies  of  the  stomaeli  are  eutarrh.  atrophy  o 
inland-.  Li'asirie  nleer.  and  linallv  cancer.  In  the  l!r-t  tii<-re 
<|tiaiititv  of  rupv  mucus  ^iven  oil',  and  a>  the  food  m  the  stoma 
rolled  over  and  o\ er  it  liecomes  ^radnaliv  covered  wit  h  a  wrapp 
this  mucus,  upon  which  the  ^a-tric  juice  is  impotent  to  exercise 

dl!_re-t!\e   elfeet.         The    fooi  1    Wllll    Sollle   ^astl'lc    JHIce    i-    !  .  k  e   ;i    pnd 

iii   a    ha^r,  and  feels   like  a   dead  weight  in    the  stomach.      It  is 
oli\;ou<    that    in    such  a  case   all    solid    food    mi;--:    lie    reliLr:"ii~! 
jureii:    and    such    food   onlv  lie  taken    a-   can    not    1><-  so  ciifoide 
mucus.       I-'luid  food  alone  must   lie  taken    -that    is  o!iviou~. 

Atrophy  of  the  glands  of  the  stomach  involves  functional 
paeitv,  and  onlv  food  of  tlie  most  diircslililc  nature  should  he  ta 
l-'oo.j  which  is  not  acted  <m  !>v  the  stomaeli  so  much  a-  l>v  the 
creas  is  here  indicated,  and  that  means  that  miik  -hoii  d  fo 
laru'1'  portion  of  the  dietary.  Farinaceous  matter  :-  ii!ijeet:iH 
—  hut  not  ~o  pred  iLi'estei  i.  or  so!  ti  1  tie  i  -a  r!  >o  h  vd  I'ah'-. 

In  gastric  uleei-  t  here    is   little  or   no  lii-comfoiM  while  i  he  o 
is  at  rest,  luit    as  sunn  a-  loud  enter-  it   pain   i-  se!   i;p.      T! 
part !  \'  to  the  acii  I  iyasi  ric  ju  ice  irritat  inu'  t  lie  raw  HI  r  face  ,  ,f  the  11 
partlv   to   the  dr.- 1 '_;••_;•  in",'   upon    the    has"   of   the   ul-er   cau-ed    !'\ 
inu sen ia r  movements  of  the  stomai'h  .-''t   UN  i>\   the  nre-euec  o!    : 
Vomiting  at  once   ^iM-s  relief   from    Imth  cause-;  of  H!tl'er'!:'j-. 
ail\aiie~  are  indicated,  and  milk  coin ;I;IU!!L:'  -ome  alka!      -  :i!'»'; 
oidv  food   that  can  lie  taken  without  sntTerinu'. 

In  cancer  of   the  stomach    pain  is  ~et   up  l>\'  mo\einen'   •  •>  >  • 
hu;   i  hei'e    is  a  1  si  i    pain  \\  lien  t  he    -tomach    ;-  empt  v.      (  'o"  -  . 
cancer  is  M-aled  ai   I  he  pvlorv  r:ii'_r.  and    pa:n     -   can-' 
sai;'e  o!    food  iitit  of    the  stomach.       Here   on.\    :';.••  n. 


1.V1  M. \NTAI,    OF    JHKTKTK'S. 

foods  can  lie  taken  without  suffering,  and  towards  the  end  all  food 
airirnn  ates  t  In-  sull'ering. 

'I'o  show  what  inav  In-  done  l>v  a  suitable  dictarv.  the  following 
case  is  instructive.  An  old  lady  at  lirixton  sufl'ercd  iniieli  from  pain 
and  sickness  caused  hv  cancer  of  the  stomach.  A  liini|>  as  bi^  as  a 
doulilcd  list  could  he  distinctly  felt.  Yet  l>v  putting  that  old  ladv 
on  a  strict  dietarv  of  lluid  food  and  prcdi^vsted  carbo-livdrates  the 
stoiuacli  quieted  do\vn.  lliere  was  no  sickness  and  no  pain,  and  at. 
the  end  of  a  week  the  friends  asked  the  regular  inc'dical  attendant 
if  tlierewas  not  some  mistake  in  the  diagnosis.  So  great  was  the 
relief  ail'orded  that  the  patient  lived  on  until  cancer  broke  out  else- 
where; indeed  it  was  some  months  before  she  succumbed,  when  she 
had  onlv  seemed  about  a  week  from  the  inevitable  end  when  the 
change  of  food  was  begun. 

The  great  matter  about  any  disease  in  the  stomach,  anv  gastric 
irritahilitv  which  mav  crop  up  as  an  intercurront  trouble  in  the 
course  of  ot  her  maladies- -as  phthisis  for  instance — is  to  introduce 
but  a  small  bulk  of  fond  at  once  into  the  stomach.  That  is  the 
fundamental  matter  to  be  kept  ever  in  the  centre  of  vision,  and  not 
onlv  that  but  well  focussed.  It  is  too,  the  central  affair  round  which 
all  the  rest  turns.  Metaphors  awl  similes  might  lie  multiplied  in- 
detinitelv,  but  no  amount  would  be  too  great  for  the  subject  matter. 
"  Bulk  "  is  the  first  thing  to  attend  to. 

Small  quantities  of  meat  broth  thickened  with  baked  Hour  but 
so  thickened  that  the  eye  can  detect  no  mass;  milk  with  \'idiv  or 
Yars.  or  other  like  waters,  these  are  the  staples  of  the  dictarv.  To 
t  hese  mav  be  added  malt-extracts  (marvelous  food  in  bad  gastric  cases) 
where  the  patient  does  not  dislike  them.  Small  (plant  it  ics  of  the 
svrnp  of  stewed  fruit  are  often  grateful  to  the  patient.  But  in  the 
milder  cases,  some  boiled  while  lish  mav  be  borne  and  forms  a 
change.  Sometimes  a  very  strict  diet,  with  the  patient  in  bed  to 
economise  the  powers  and  reduce  the  body-expenditure  to  a  mini- 
mum mav  In1  enjoined  for  a  definite  time,  as  a  curative  course  m 
ulcer  or  catarrh.  Such  a  severe  regimen,  eked  out  bv  nutritive 
enemata.  will  do  much  towards  a  cure,  even  in  verv  bad  cases,  and 
achieve  one  1M  >I  lirhter  case<. 

\Vheii  then  -  a  i:reat  excess  of  acidity,  vomiting  gels  rid  of 
much  of  tin1  olTending  acid.  Milk  is  returned  in  firm  curd:  and 
mu~t  be  ^iven  with  some  fixed  alkali,  as  prepared  chalk,  or  liu'ht 
inaL'iic.-ia  a-  much  as  will  lie  on  a  six-pence,  or  sometimes  even  a 
shiiiinir.  to  the  bait'  pint  as  lime-water  or  aerated  alkaline  waters, 


!•'<  M  i|)    IN    (  JASTKIC    Al'l  r.t    1  |i  >NS.  \  .',., 

are  not  strong  enough   to  neutralise   the  acid.      ![••:•.-.  HUM: 

enou-h    tn  secure  I  he  de<nvd   end  are  e->en  t  '.a  1.        M'-a!    infu- 

|ire|iarccl  carho-hydratcs,  m;tv  he  exhihited.      i  'an--  -u".a:- 
nation  in  llioe  cases.      \V  hdi  .-li^hi   hut  chp  •:  ;••  acj.ii;  \    -coinp 
of.    cane  Miirar  niii.-t    lie  abandoned,  and   other   form-   of  suirar 

lielllLT   '"'''I    SllllSt  it  llted     for    it.         llli'leci!,     hl'ieflv.    Sllei-p  i.~(-s    nr    e  I'  V  -I"'?.! 

lisaoie  sugars.    which    readily    undergo   acetous    t'ermei.ta;  i"U.    m:: 
lie  u'ivcii  uji.  ami  ^'1  iii-"Si's,  i  T  uncrvstallisaMe  su^ai'.  takf!'.   in   th":r 
str-iil. 

In  those  eases  where  thirst  prompts  the  siitTere;-  i»  ^u!p  ilo\vn 
a  ^'ooil  ilrauirht  of  tlui'l.  \vhieh  the  stoniaeh  pruiupt'.v  rejei-t-  ai.d 
ejcets.  it  is  well  topve  the  patient  .-mall  [licees  of  i-e  to  silek.  The 
melting  ice  cools  the  drv  fauces;  ami.  int  i'oihiee'1  in  thi-  -•'•':''•• 
iiiatinci'.  the  stoniaeh  tulei'ates  the  presence  df  (luiil.  It  i-  jid--:!/i'. 
hv  the  use1  nf  ices  containing  t'ru:;  svrup  or  cream,  to  intr<nluce  a 
small  ((iiatititv  of  ndurishiin-nt  into  an  irrilahle  st.iinach.  \\  !;.-ii 
the  stomach  is  in  m-tive  revolt  ar.'i  ohjeets  [n  ali  contents,  it  ;s  ;i 
matte!-  tif  life  or  death,  vcrv  often,  how  far  food  can  |  .•  introdn'-'-d 
into  it.  Ilunirer  and  thirst  Imth  are  cxperieneeil  :  while  in  manv 
case<  the  pat;ent  manifests  an  intense  dislike1  to  feeilin^  /«•/•  /••  -  '  •//. 
\\diei-e  the  latter  is  well  l>orne.  the  dillieu'.tv  i<  small;  hut  where  the 
olijeetion  to  eiiemata  is  insuperahle,  the  Create-;  diHieultv  may  he 
encountered. 

When  t  he  (piant  itv  or  hulk  of  food  which  is  tolerated  a;  on  •••. 
is  small:  the  meals  must  he  the  more  frequent.  If  t  hcv  are  sutli- 

c-iellt    to   he  called    llleals.    t  hcV  slloll  Id    1  .....  f    the    fill!    UUIliher     -hi'eak- 

fa.-t  .  eleven  o'clock,  luncheon,  tea.  dinner,  and  supper.  Half  a  do/en 
hv  no  mean-  too  manv.  When  oniv  two  or  three  ounce.-  of  ;!';:'; 
food  can  lie  taken  at  once,  then  the  feeding  times  -hoti'.d  niiinher  a 


tolei-ateil.  cverv  hour   is   not  ton   often.      The  smaller   the   hulk.  ;! 
shoiMer  the  interval—  else  the  patient   w:;l  starve. 

Sometime-  the  patient    luathcs    the  onlv  food  which  is  suita'> 
hatc-s  heef-tea.  cannot  take  milk,  eii'irs  disagree;    (and  oflei:  the  \ 
of  an    c^-j;  is   --ood.   where    little  can    he    horn'1  at  o;;ce.  i      \\  !:a' 
hedoiie;'      Ti'\'  a  t  caspoon  f  ill    of   malt-evt  ract    evcrv   hour.       !••    ' 
new    food,  not    handicapped    hv    mc-moi'ies   of  nssociationy..  ;t    •_ 
fair   trial,  and,    often    succeeds,  espec;aii\    with    fema  '•-,      t  >••   : 

piece,     the     -;/.e     of    a      !ia!Velolia     IlUt,     of     ('ft  Hl'if    II  '.>,    I!   .1 

ti-iecl  hourly. 

The  resources  of   the    |  ih  vsiciaii  are  oft  en    ta\c.! 


i:><;  MANTAL    OF    DIETETICS. 

troublesome  sloiiKicli  cases,  but  success  often  is  the  reward  of  ex- 
tensive acquaintance  with  food  of  all  kinds  and  qualities.  Hut 
then,  this  acquaintance  is  onlv  possible  bv  long,  watchful  attention 
to  the  subject. 

The  principles  of  feeding  in  gastric  cases  are  the  same,  whatever 
the  form  of  disease,  though  in  minor  points  some  variation  mav  be 
siiu'iresied  bv  the  individual  exigencies  of  each  ease.  The  digestive 
act  remains  the  same,  whatever  the  precise  form  of  disease.  Small 
quantities  of  readilv  digestible  food  at  once,  is  the  secret  of  success. 
Knemata  of  soluble  carbo-hydrates  and  peptonised  meat  come  in 
verv  conveniently— there  is  no  palate  to  be  oil'ended  in  feeding  /><'/• 
red  ii  nt. 

Of  course,  there  are  always  the  individual  likes  and  dislikes  to 
he  encountered ;  as  also  the  fact  of  certain  foods  disagreeing  with 
the  patient:  t  wo  mat  ters  which  often  tie  one's  hands  very  awkwardly 
in  dealing  with  cases.  And  it  is  in  women — in  whom,  as  compared 
to  men.  assimilation  is  imperfect — that  these  disturbing  factors  are 
encountered  most  frequentlv.  When  the  assimilative  power  is  very 
small,  the  patient  must  be  put  to  bed  and  the  room  kept  warm,  to 
reduce  the  body-expenditure  to  a  minimum.  The  amount  of  food 
which  will  "sustain"  life  under  these  circumstances,  is  surprisingly 
small.  And  after  a  period  of  comparative  rest,  the  appetite  and 
power  of  digestion  return.  Such  a  case  was  put  on  record  by  I'ro- 
fessor  See^ens.  where  for  thirteen  days,  but  thirty-live  grams  (.")  15 
grains)  of  milk  were  the  sole  food.  After  that,  the  appetite  re- 
turned, and  considerable  quantities  of  milk,  an  egg  and  some  arrow- 
root, were  taken  dailv.  It  is  possible,  too,  to  give  some  food  to  such 
patients  bv  having  them  rubbed  with  oil.  Absorption  bv  the  skin, 
even  if  small,  is  of  priceless  value  in  an  emergency  of  this  nature, 
wii'-n.  indeed,  every  litt  le  helps. 

Sometimes  violent  and  irresistible  cravings  for  food  of  the  most 
apparently  unsuitable  character  are  experienced.  It  becomes,  at 
time.-,  a  matter  of  no  small  dilHculty  to  decide  upon  whet  her  these 
cravings  shall  be  ^rat  i  lied  or  not.  Kxperience  has  shown  that  fre- 
quently the  food  so  craved  I'm-  has  agreed,  despite  all  a  /irmri  objec- 
tions; and  consequently  furnishes  an  argument  for  yielding  to  the 
patient's  desires.  (irantin^  these  exceptions  to  the  rule,  the  broad 
rule  remains  of  small  quantities  of  liquid  food  at  frequent  inter- 
val- in  all  eases  of  disea-e  of  the  stomach.  Of  course,  this  does  not 
thru-t  out  of  .-iLfht  the  fact  that  the  stomach  requires  its  own  inler- 
\ai-of  physiological  rest:  but  the  smaller  the  meal  and  the  more 
digest  ihle  its  nature,  tin-  less  this  interval  is. 


(MIAPTKK    XVIII. 

F(M)I)    IN    STIM'MA. 

Tins  is  u  very  important  matter  al  tie-  present  time,  vrun::: 
is  tin1  Word  IHi\V  ill  use  111  lieu  of  scrofula.  Scrofula  u  a-  ai'M  '.•••  \  In 
that  suppuration  of  the  cervical  glands  which  followed  upon  eularire- 
liicnt  n!  these  ^iand-:  ami  'jnl  it-  term  from  Scrnfa,  a  -ow.  from 
t  In1  porcine  appearance  of  the  neck.  This  it  \vis\\hii-li  caused  tin- 
1'niice  Urgent  to  adopt  thosi' voluminous  lu'cktii's  \vhirh  wen-  \voni 
in  tin1  rarlv  part  of  the  pivscnt  centurv.  li  \\a-  vul'_r:U'lv  kii"\\n  a- 
"the  Kind's  Mvil"  liccause  it  was  lu-lii'vcil  it  \v;i-  ciiralilc  !«v  tin- 
roval  ti'iii'h.  I'rolnililv  then1  \v:is  souirt liini;  ;u  tin-.  Inn  ni'iii'fi-;  ,\ , 

lint  ilin-rilv.  Tlli'i'lllM  U'llii'il  SUrrtM'ili'il  111  ^''ttlllLT  Id-fiv-s  to  tin- 
royal  (ouch  \voiili!  proha'ilv  after  t  hat  u''1!  tli«- supi-rinr  frc'iin::  aii'l 
n-^inii-n  whi'-h  i-  so  ii-cful  in  stninimH,  or  si-roi'iilmis  all'i-et  ;I>IH. 

St ruina  is  doselv  linki'il  \v:th.  if   not  rrallv  a  lii'pravr.i  urLran:-ni. 
with    tissuc-dt'Lrrailation.      Then1    i<   a   i-crtain    ciilarp-nient    of    tii,1 
epiplivscs,  often  itotici-jihU1  111  the  kt:ottnl   iiu^t-rs,  larii'e  al   the  jn:::t-. 
the  liniH-s   as   a  rule    heinu'  small   and    iiLi'ht.      The  musi-li'-s  an-  small 
and    apt  to   In-   llahliv.      The  lips  ai'e  thiek  and  sn  are  the  al:i-  of   ih,- 
nos".      The   t'Vebrows  are  often  \vell-inarked.  and    either   straight    "f 
hi^lilv  arehed.      The    little    fairv   child,  ii-ualiy  a    \i\r\.  with    li',o>i,i.- 
hair,  wrll    vaulted,    fondiead.    elearlv   ill-lined    e\elirow>.   pniil:u^       p. 
and   ai'eliness  of  expression,    with    IOULT   »ilken   r\el>i-o\v-.  •-   a    - 
niou-  ehiid:    and   will  nsnailv  not    survive   did  lliood.       I; 
t  I'ast   to  t  he  heavy  plain  child  of  coarse  1 ;  MI  >a  i  iii -nt  -.  thick   up-.  l>rok>" 
or   stunted    evdashes.    enlarged    eervieai    Lrlands.    and    i-;iinis\     f'U-iM. 
not    iinroninioidv   seen:    i-oih   are   alike,    if    not    t-i|iiai!y    >!ruiii";-.. 
The  -TC;M   Icvieo^i'aplier.  Sam  .lohnson.  had  distinctly  st  i-iiuicr;- 
tun-s.  with  the  knoMiv  hand  of  i-oiilirnied  -irtima.       lie  \\:i- 
the  la-i  \vho  was  touched  for  the  "  Kind's  e\il  ":  and  i  IP  >!;•_ 
nut  serin  to    have    henetited   much  therefrom  wa<   a    hi-'ote. 
promising:   trne-lilue   Torv  all    hi-  day-,       l'rot'f--or   I.ayco-k    - 
person-   of   the   striimoiis   iliathesis.  lha:    tiieyex! 
vllal  force  manife.-ted   l>v  defective  n  u;  i':t  :••!;.   impi 
and  delii-u-nt   function."      And    ai-o  o!    tln-.r   !"m\  de\e.oi'n:i 


1.".^  MANTAL    ()!•'    1  >1  KTKTH 'S. 

it  is  "df  a  retrogressive  type  towards  the  infantile  or  a  lower  ethnic, 
form."  Of  the  nervous  system  it  is  "  irritable,  feehle  in  tone,  mind 
precocious,  hut  mental  powers  impel- feet,  or  if  good,  soon  ex lia listed." 
a  "lower  ethnic  form  "  of  individual  marked  l>v  precocity  and 
ear!  v  exhaust  ion.  In  its  slighter  forms  stnima  i:'ives  us  ourtvpe 
of  heauty:  hut  it-  is  an  unhealthy  type.  The  precocious  fairy  child 
will  never  make  a  strong  healthy  woman,  lit  to  he  the  mother  of 
children. 

Of  what  may  he  called  the  cause  of  the  strnmous  taint,  the  de- 
terioration of  the  pliysii|iie.  the  following  illustration  is  fraught  with 
instruction.  In  mv  early  davs  of  practice  in  Westmoreland  a  family 
tainted  with  stnima  were  among  my  patients.  The  father  was  a 
man  of  fair  physique,  of  the  nervous  diathesis;  while  his  wife  he- 
longed  to  a  moderately  strumous  family.  In  their  early  years  of 
married  life  they  were  prosperous  as  working  folk,  and  their  first 
children  manifested  little  of  the  strumous  taint,- — -had  indeed  just 
enough  of  it  to  give  piquancy  to  the  expression.  Then  the  father 
took  rheumatic  fever  which  injured  the  valves  of  the  heart,  and 
crippled  him  so  that  he  hecame  very  poor.  The'  children  horn  dur- 
ing this  time  had  more  marked  stnima;  their  noses  were  stnhhy  and 
their  eyelashes  hroken  and  defective.  Then  the  father  had  some 
money  left  him,  and  their  circumstances  hecame  easier  and  their 
regimen  hetter.  The  two  children  horn  after  this  improvement  in 
t  heir  circumstances  resemhled  the  lirst-horn  children  in  the  slight- 
nessof  their  strumous  taint.  The  family  group  was  a  most  instruct- 
ive one. 

( )ne  curious  matter  there  is  ahout  strumous  children,  and  that  is 
the  amount  of  uric  acid  in  their  urine.  ThcvaLsoare  liahle  to  acid, 
or  .-our  perspirations. 

Stnima  is  a  departure  from  the  normal  in  a  downward  direction, 
hoth  as  to  development  and  nutrition;  and.  consequently,  has  to  he 
met  hv  good  food,  fresh  air.  and  indeed,  everything  which  will  tend 
to  rai.-e  t  he  />////*ii///r. 

In  i  he  tirst  place,  it  is  very  nndesirahle  that  sudi  a  child  he 
suckieil  hv  the  mother:  especially  if  the  strtima  come  from  her 
side.  When  a  wet  nurse  is  sought  she  mii.-t  first  lie  a  perfectly 
heaithv  woman,  and  tlien  l>r.  ('omhe  ("  1'livsiological  and  Moral 
Management  of  ('hildren")  lhmk>  "that  the  nurse  should  I'e- 
.-emhle  the  mother  in  ail  the  characters  in  which  the  latter  can  he 
coi  -  dered  henithv:  she  should  !»•  nearly  of  the  same  height  ami 
huik.  for  it  has  heen  noticed  that  the  chiM  of  a  tall,  thin  woman 


Ft  M  M>    IN    >Ti;i   MA. 


rare,  ,-    thrives    upon    the    iniik    of   a    woman    of    - 

thickset.         It     is     also    a(     -Teat     importance     th..- 

hcen  delivered  as  nearlv  as  possihle  at    tin'  .-ante  ;.me  ..- 

a  lieu-horn  rlnM    nursed  uj'oii  niiik  ;i  few  ino.ith.-  o-i  is  ',•  :  ••> 

\-i\v  thai  the  wet   nurse  is  ^oinijc  out  of    fa-hiou,  attention  ;.i  h--: 
is  less  necessary  than   ii    was.       lint  I  he   nii.k    supplied    to    the   .        d 

-hould  lie  of  cxeellent  i  j  lla  ',  I  h  \  ,  a  1 1'  1  if  |mssihle  Hot  that  of  -;  a  h.e-le.; 
cattle  ill  t<>\vu  dairie.-.  "  It  is  a  curious  fae|  that  iiie  miik  ><\  a 
tuhcivulous  eo\v— an  annual  \vhieli  i-  \erv  stihjeet  \«  i  nheivuious 
ilisea>es,  \vlieii  confnieil  ;n  ,-talnes.  as  tlp-v  fi'euiieni , v  afe  !ii  laf^e 

cities-  —  lias   heell    tulHlll    to   contain     SeVell    tllll'1-   a-    [Illleh    j  i]  10- j  iM;i  •  .•   nf 

1  in ic,  I  he  main  in^'i'e'lient,  of  scrofulous  tuhercie,  a-  i  he  niiik  o'  a 
heah  hv  an  iiual.  "  ( IJaudi'loctiiH' (|iioicil  hv  Lu^oi  "()n  Scrofu.a.") 
'I'he  niilk  .-houM  lie  from  a  countrv-feil  co\\.  li\:u^1  ;n  u  ha;  ma\  'ne 
tcniictl  a  imnnal  manner,  and  leading  a  naturai  i.fe.  Not  oiiiv 
should  such  children  he  eaivfuliv  fed.  hut  thev  -limiid  he  reared  ,M 
the  coiintrv  under  circiiiustaiiccs  the  most  favourahn-  for  rne,  .u:-;i_'- 
ini;-  development.  And  without  this  Sir  •'.  <  lark  though;  "ad 
our  etl'orts  to  improve  their  health  w;ll  fan."  'l"ne -ood  foo, •  mn~; 
he  hacked  u[>  hv  everv  oilier  advantage.  "  The  -.-]'o;'u  ,,,u.  eiid>i 
should  not,  uierelv  live  in  the  coiintrv  hut  should  he  a-  much  a- 
possihle  in  the  fresh  air.  1  have  fre<|tietii  i  v  had  ocea.-ion  to  iioi;,-e 
the  extruordiiiarilv  irood  elTects  which  an  out-ofdoor  l;fe  proiiucr-; 
upon  scrofulous  d i -ease  in  t  he  ease  of  i-liililrcii  who  during  i  lie  per.od 
of  IT  lean  i  HL;'  are  m  the  tields  i  rom  sun  rise  to  sun~ct  for  da  vs  ;  o_;-et  !,.•;'. 
Scrofulous  glands,  as  well  as  other  form-  of  sti'iinioas  iii-ea-e,  ;Ve 
(jiieiit  i  v  uiii  teru'o  a  not al ile  aiiU'lioral  ion  duniiLT  I  in-  t  -me.  "  <  I  .';jo..  ) 
The  ad\anta'_;'e  of  setidilm"  such  children  to  ihe  -ea-;dc.  wlie|-i-t  in- 
whole  iiav  is  s|ient  in  the  open  air  \\hen  I  he  weather  perrufij  : 
ol  i\",  oils.  "  The  seaside  and  eml-l  1  \  er  oil  "  i  -  tile  |-i  1(1 1  .  !ie  pre- 
tion  for  such  children  when  aU'ected  with  sonic  -.rui'u;.  .;i-  ;:-o\ 
in  t  heir  joints. 

There  is   in    strum  on-  children  much  tendene\   io    ii.-ea-i1 

hone-.        The     I'll  H     have     thickened     eplphvses    a!      ':,e'r     ':ir:     :._• 

i-xt  re  unties;    "  the  rachit  ic  ^a  riand  "  ..-  the  name  -  ,\>  '. 
of  en!a  PJ;V<  1  costal  ep;  ph\  se.-. 

]/,,,•/,,'.<  m. iii/-/  //.v  i-  also  common,   from   -onie  -:i..eA.  ., 
a  con-i'dei'ahie  liei^'h;,   hriii.-in".'  either  ;h-e  h.t--ad    . 

clip     of      the    hi  [I- hone-.          I  »i.-e;He     ,  ,  f     I  1  ,  e    ,    '.  :  ,,  i  \    ; ,  ! , 

(silent.      The  .-pine   i-  ant .  too.  io   lie  a  :;'••  •••   . 


Jt'-i>  MAM'AL   OF    DIKTKTICS. 

single  or  double  curvature,  or  even  caries.  The  music-stool  ^iviu^ 
no  support  to  the  l>aek  1ms  been  held  largely  to  lilatne  for  this.  In 
the  old  starvation  davs  for  school-fjirls,  the  inipert'ect  osseous  dcvel- 
opuieiit  of  struina  was  verv  frequent.  In  a  lareje  school  visited  bv 
Sir. John  Forbes,  not  line  of  the  fortv  jjfirls  was  free  from  some  crook - 
iu^  of  the  spinal  column.  And  of  these  school -^irls  Sir. J.  Clark 
said —  "  \\  hi  le  the  nat  ural  form  of  the  bodv  is  dest  roved,  the  general 
lieahh  sulVers  ...  In  short,  all  the  requisites  for  the  produc- 
tinii  of  strumamav  lie  found  in  a  larvje  proportion  of  boarding- 
schools  when  the  svstem  described  was  pursued.1"  I>ut  anv  such 
expression  of  opinion  ahoiit  boarding-schools  at  the  present  day 
would  lie  incorrect  and  unjust.  Still  the  matter  of  feeding  delicate 
children,  and  especially  girls,  is  a  verv  important  one.  in  the  matter 
of  Lrirls  more  than  hovs.  because  the  advent  of  puberty  and  the  in- 
rush of  new  ideas  consequent  thereupon  seems  to  affect  more  t  he 
palate  in  them  than  boys.  Slate  pencil  and  chalk  seem  the  articles 
most  craved  after  l»v  the  depraved  appetite  of  school-^irls;  and 
neither  have  a  food-value,  while  the  chalk  locks  up  the  bowels. 
Consequently,  irreat  care  and  supervision  is  requisite  to  prevent  ir'fls 
caiiuLT  what  thev  should  not  have:  as  well  as  to  see  that  they  eat 
what  t  hev  oiiLfh t  to  eat. 

Strumous  children,  from  an  early  a  ire  exhiliit  a  strong  tendencv 
to  form  an  excess  of  uric  add. *  It  is  seen  in  crvstals  in  the  chamber 
utensil-;:  and  LTIVCS  i'isc  to  sour  acid  perspirations.  (It  is  not  asserted 
that  uric  acid  i<  found  in  the  perspirations,  onlv  that  thev  arc  sour.) 
I'robahlv  this  has  something  to  do  with  the  orood  Hl'ects  of  potash 
upon  strumous  children,  to  which  I,u:_r"l  bore  his  testimonv.  He 
oli<cr\'ed  that  the  administration  of  potash  had  a  <_rood  ell'ect  upon 
tin-  maladies  when  present,  "'without  in  anv  way  lessening  the  ten- 
ileiicv  to  a  lVe-h  tubercular  deposit." 

\\  here  it  seems  desirable,  to  administer  potash  (which  is  not  verv 
palatalilc),  it  mav  be  ^iven  in  the  following  mantier,  without  olTence 
to  the  pa, ale.  'I'o  eaeh  pound  of  fruit  when  put  into  the  oven  to 
slew,  add  a~  much  potash-bicarbonate  as  will  lie  on  a  dune  or  a 
quarter  bit  (in  Kniriish.  a  six-pence  or  a  shilling.)  This  will 
itdit  rali/''  the  excessive  aciditv  without  the  taste  of  potash  he  in;: 
present.  Then  some  su^ar  mav  be  added.  Such  steweil  fruit  with 
cream,  would  form  a  desirable  factor  in  each  dav's  food. 


Then   collies   the   (jlle-tlon    of   fat.         I-'al     is    Heees-ar\    :'"" 

lion    of    healtliv    tissue;    and    when    there    i-   a    di-tinet    ;<'., 
tissue-deirradalinn     fat    becomes   even     more    imperali\el\     i  —  i,;  ..  . 
Hut  then  t  he  st  ruinous  child  turns  awav  from  fat   with  !»at  :.i  !:•_•.       [• 
revolts  from  a   piece  of  sweet  animal  fat  :    ;;    1 11  rn  -  a  \\  a  \   from   n1; : 
bread  and    butter  when  a  stout    slice    of    hread     i-    co\r|-ed     h\    a   i; 
laver  of  hiitter.       How  then  is  the  requisite  f.;t   to  he  introduced 
the  organism  ?      I' v  means   of   cod  liver  oil    ^tveii  an  hmir  after  eaeii 
meal  !      Certainiv:    hut   is  end  liver  oil  the  lies]  or  the  mos;  de-:raMe 
form    of    fat  y      Tliat    mav    In-   questioned.       1'rnfcssor  ,lohn    Hughes 
Uelinett    ill!  rod  llced   t  'tie   Use    of    cod     liver  oil;     hut    Luu'o]     had    Ho  ex- 
perience   of    it.   he  savs.       Its  n-c  soon  lieeame  general    ;n   ad    scrofu- 
lous ainl    tulierciilons  atVect  ions;    and  \\diat   i-  more,  ;t   ha-   st 1   the 

e'rim  test  of  time,  and   hold.-  its  ground  a<  lirmi\   a-  ever. 

The     iisliv    oil     IS     relished      hv    lliailV    children     whetl     on     a     /'/'•'•• 

grounds    it    m  i".'!  it   lie  thought    the   child    would    di-Td<e    it.      (  >n    the 
contrarv,  it    is    taken    hv    main    delicate   chiliireii    as    ivudilv  a- 

piece   of     \\  hale    hluhhlT    hv  all     K-killlo   Ii;il)V.        The    fa  i    si-elll-    t"    Hie.   t 

an  inst  inct  i\  e  wan; .       I  'r.    1\  ;I:M'  ( 'ham hers  tells  i  he  ia;e  of  a  pht  i; .-. 
cal  Skve  terrier  who  whined  for  his  cod  liver  oil  if  forgotten.      O;her 
children  take  ^reeililv  the  nil    from    canned    sardines:    a  form    of    fa! 

Then  there  arc  other  wavs  of  introducing  fa;  without  <•!;'•  nd.nu' 
the  eve  or  the  palate.  (if  these,  milk  stands  !ir.-l  and,  forcitio.-t ; 
cither  jilain.  or  as  mi'k  puddings,  or  as  an  adjunct  t"  porridge. 
Then  cream  mav  he  eaten  with  .-tewed  t'rn:;.  ('ream  too  mav  he 
served  up  at  tahle  as  cream  moulds  variously  thnoured:  cotitainini: 
cream  wi'h  sonn-  farinaceous  matter:  or  as  nierin^'iii'S.  A-  \\hipped 

cream  it   is  a  pleasant  acconnian  i  men  t  to  man  \  cold  pud  dinars, 

i  i 

there  is  luitter.  which  can  he  added  to  hread.  and  some  potted  meat 
in  thin  sandwiches,  svheiv  somcthii;^  tasty  is  relished:  or  it  can  he 
adiieii  IVei  iv  to  mashed  potatoes,  or  eaten  \\-\\\\  milk  ptuld, m-j'-  eitlier 
hot  or  cold.  It  is  to  he  found  in  olcohvne.  Wln-n-  ecouoim  js  :) 
matter  of  momeiii  then  suet  puddings  SU^LTCS!  i  hem-e,\  t  -.  j1,,,; 
cracked  and  .-tewed  \\lth  rice  arc  an  exceilent  fatly  '.' 1.  eh 

haked    heaus   of    New    I'iii'j'iatid    furnish  a   :ar;_re    proportion    of    :'at     n 
a    plea-ant    form     not    likely    to   oll'end    the    palate.      Th-   a!-o     • 

t  L-  I 

economical  toou. 

Then  there  remains  one  more  food,  ran  iv  looked  at 
value  point  of    \  iew.  and   1  hat     :  -    "  '['>  'll'i'c.  "      T.h      C.III.H. 


lt'>l'  MAM'AL   OF    DIKTKTU'S. 

and  siiLrar  is  acceptable  to  the  palate  of  most  vou Masters.  The  old 
original  totl'ee,  made  when  butter  "U'as  elu-aj)  and  su^ar  dear,  is  the 
form  to  lie  adopted  when  it  is  desirable  to  all'ord  fat  to  the  svstem. 
The  increasing  price  of  butter  lias  reduced  tofl'ee  (in  most  instances) 
t"the  level  of  a  mere  carbo-hvdrate:  \veil  enough  as  a  fuel  food,  hut 
inoperative  for  tissue  const  ruction.  In  my  experience  many  a  little 
stnunous  child  whose  palate  revolted  at  cod  liver  oil  has  been  saved 
from  death  bv  liberal  supplies  of  totl'ee: — though  its  mention  usuallv 
provokes  a  smile  of  derision  and  a  sceptical  remark  from  the 
mother.  She  soon  however  sees  for  herself  the  beneficial  ell'ect  it 
produces.  Incredulity  u'lvcs  wav  to  j^rat  it  iide:  just  as  of  old  those 
who  came  to  scoiV  remained  to  prav.  There  is  other  conversion 
than  religious  conversion  ! 

In  struma  advantage  can  be  taken  of  the  ready  absorption  of  fat 
by  the  skin.  Children  readily  admit  of  cutaneous  inunctions  beinir 
applied  tn  them.  In  a  warm  room  the  child's  trunk  and  limbs  can 
easily  be  sponged  over  with  warm  water  and  soap  so  as  to  cleanse 
the  surface,  after  which  oil.  which  has  previously  been  warmed,  can 
be  applied.  It  should  be  rubbed  over  the  skin  freelv.  This  can  be 
done  one  or  twice  daily.  Cod  liver  oil  probably  is  most  read ilv  ab- 
sorbed, but  its  smell  is  objectionable.  Then  comes  neat's  foot  oil, 
also  an  animal  oil:  olive  oil  is  less  o (Tensive  than  either.  Such  in- 
unction in  eold  weather  forms  a  ^ood  protection  against  cold. 

After  a  suitable  regimen  under  favourable  circumstances,  as  an 
outdoor  life  at  the  seaside,  the  system  will  often  ^n-atlv  outgrow 
its  strumoiis  tendencies,  and  a  fairlv  heultliv  organism  be  attained: 
where  if  no  steps  are  taken  the  svstem  simplv  gravitates  deeper  and 
deeper  into  conliriiied  struma:  and  sinks  ultimately  under  some 
tuberculous  or  scrofulous  disease.  The  preventive  treatment  of 
stnmious  affections  is  a  ^reat  matter.  \\hen  some  joint  ha-  been 
e\ei.-ed  or  mischief  .-hows  itself  in  the  mesenteric  glands,  or  the 
hi!i">.  I  he  nbove  scheme  and  regimen,  have  to  be  adopted  as  a  cura- 
tive measure. 

The  ".Teat  food  for  the  strumoiis  is  "  Fat." 


CTIAPTKU    XIX. 
K(M)D    IN    AX. KM  I  A. 

TIIKKK  is  a  t  nil  In  icy  in  youth  and  especially  \vitli  irirls  t>  ln-com, 
ana'iiiic.  or  hioodle--.  \\  hv  tin.-  should  l»-  is  m>t  \ITV  clear:  in;!  . 
seem-  prohahle  that  the  demands,  of  growth,  of  puhertv.  and  i. 
work,  school  IT  other,  made  upon  tin-  organism,  lower  the  capa'-ir 
for  .-aiiLruitieation.  N<>  donht  in  smut-  casr.s  inhci-iti-.l  >\'tih:!: 
factor.  TiifM  i-xpfisun-  to  nialai'ial  inlliifju-i-s  inii'i-fi-n-:  witii  t;.> 
Format  inn  of  hloiMl-corpuscIi-s.  as  wrli  as,  pruhaMv,  li-adin^  to  ;:, 
rapi'i  il i-inti'^rat  ion,  or  \vrariii'_;'  out  of  thr.-i'  I'nn1  Innlirs.  Ati\  !I[OM 
poi-dii  i-arrii"  \vith  it  a  tcmlciicv  to  aiia-m  :a.  aii'i  ul'ti-is  to  nrtira'^la 
"  I'ain  :-  ill''  prayi-r  of  a  nci'vc  for  ln-ait  hy  Momi."  ,-aM  li'oin!"'i'_ 
ami  pain  is  t'ouml,  cspri-i  illv  m-ural^ii1  pain,  \vhcri-vi-r  tin-  iii'm.i 
impiiri-.  or  lii'tirit'iit  in  (piatititv.  ( 'oiiscipn-ntlv,  \vc  tiii'i  in-Mi-a  -.: 
nii'li'i'  tin'  iiio-i  opposite  ciri'iiiiistances.  \i/.,  MOO,!  impuritv  on  \\\, 
one  liaml.  ami  poverty  of  MOO.!  on  the  other.  Ana-mia  then  ma' 
he  simple  from  det'eetive  lilooil-fortnat  ion :  or  complex,  \vheiv  t!ie:-i 
is  a  hloinl-poison  opei'atiiiLT  injnnoiislv  on  lilood  formation,  p-r'. 
even  also  destroying  the  re'1,  liiomi  corpuscles. 

(It  mav  In-  .-aid   for   the  instruction   of   non-niedicai    reader-:   tha 

the   Mood     corpuscles    do     not     feeil     the   tissues,    tllevarefcd     fl'olii     l!; 

serum,  or  //'/'""' •s'""'"'""-v  of  'he  lilood.      Si;,!,  \vhen  -a:.^i::ll>'al  ;••: 
is  ii'ooi)  t  he  u'eiieral  nutrition  i-  not  amis-.) 

It   \\:\<  been  pointeil    out   in  a  previous   chapter  that    the   ord,::a:' 
nutrition   <>f  the   Kodv  is  hut    metaholism   of   materials  funi:-h'  >1    i 
the    food,  except    ill    t  \\  o  matter-:     1 .  t  lie  ha  ma^'ioliin    of    i  he    ':•,,••, 
and,  '.',  til-'   lecithin   of   the   nervous  sv.-iem.       lla-ma^loh  n  a  a  \ 
complex  lioiiv  ;n  \\di;ch    iron  is  a  factor.      'I  he  treatment    of 
is  not    iiieivlv  the  administration  of  chalvheao--;    tii"iiL;!i    !: 
essential    part   of   t  he  I  real  meiil    nsuaih'.       If   some  spr'-:i"j.l..- 
pi'eseiit    in    th''  liloo.l,  as  svphilis,  inalai'ia.   mci'.'iirv,  LI'OI;!.  • 

Una,    i!     !-     USejc-s    to   '_^l\'e    ll'oll    Utltil     tile   '  !  : '_'  'c-t  :  \  i  •     ol'-'av,-    ; 

order    (as   a    rtile      to    \vhich    lio\\~ever.    th'  r>j    are    -om>'   , 

The    S  peel  tic    po!-ol|    mu-t     he    Diet     hv    It  -   o\Vll    all!  1'  lot  e    i  li    or  ;• 

the    orirans    m\olved    :n    sann'iulicai  ;oii   a    !a.r    lic.-i.       I  :. 


It',  I  MAM'AL   OF   DIETETICS. 

ivadilv  seen  hv  the  inutility  of  steel  ami  <n>od  food  in  a  cast'  of 
aiuemia  in  which  syphilis  is  a  factor,  until  the  proper  treatment  of 
the  taint  is  superadded :  and  then  the  dilTerenee  i-  noticealile  at 
once.  The  treatment  of  an;emia  often  fails  from  ignorance  or  lor- 
tretfulness  of  this  fact.  It  is  not  uncommon  in  eases  of  pint  and 
hiiiarv  distnrlianee  to  lind  that  weak  ana-mic  persons  have  lieen  tak- 
ing steel  and  quinine  most  earefnllv  for  some  considerable  time 
without  anv  LTOOI!  result:  and  vet.  as  soon  us  the  pun  p<uson  is  met. 
liv  ]iotasli,  or  the  liver  put  nirht  hv  hepatic  stimulants  and  ehola- 
CT"irues,  improvement,  at  oner  sets  in.  \\hen  ;i  certain  point  has 
been  reached,  then  the  iron  comes  in  most  usefully.* 

These  matters.  lvin<^  somewhat  outside  pure  dietetics,  must  lie 
pointed  out  in  order  to  prevent  disappointment.  Valuable  as  a 
knowledge  of  dietetics  undoubtedly  is.  it  must  be  remembered  that 
feedinir  cannot  do  without  medicinal  aid  in  manv  eases.  A  man 
who  has  lost  both  le^s  would  do  little  with  one  erutch. 

Puntvof  blood  and  iron  to  enable  ha-ma^lobin  to  be  made  are 
essential  to  the  treatment  of  ana'mia:  but  proper  food  also  is  requi- 
site. The  food  should  consist  to  a  considerable  extent  of  animal 
food  (except  in  puit  and  ehola-mia)  at  least  when  the  ease  has  made 
some  prou're>s.  At  first  in  amemie  cases  in  nirls  it  is  well  to  send 
the  patient  to  bed.  The  assimilative  powers  are  feebler  and  cannot, 
digest  enough  to  feed  the  svstein,  and  meet  demands  on  the  bodv 
a-  well  at  the  same  time.  To  send  the  patient  to  bed  to  lessen  the 
body-expenditure  is  the  tir-t  step.  15 v  so  doin^  even  a  very  feeble 
digestion  can  suppl  v  the  want-  of  t  he  organism,  with  a  little  to  spare 
for  improvement .  '  You  cannot  eat  voureakeand  have  your  cake  " 
savs  the  old  ada^'e.  No  more  can  a  starving  organism  use  up  each 
day's  income  and  expect  to  store  and  Darner  strength.  A  few  davs 
in  bed  i-  the  proper  start  in  marked  ana-mia.  e.-peeiallv  with  '_;ir!s. 
Tin-  is  a  lesson  experience  has  taught  me  \vith  some  liumblinir  of 
ride.  Pa ;n  is  of  various  kind-:  and  wonndinir  of  the  se] f- pride 
mav  make  as  enduring  an  impression  ;i-  the  inllietion  of  physical 
pain  -as  \vhen  they  !lo^,_,-rd  certain  healthy  lioys  in  order  to  imprint 
the  locality  on  then-  memories  in  the  old  rude  method  of  "  rid  HILT 
the  boundaries."  Sn<-!i  a  ease  occurred  to  me  \\hen  attached  to  the 
West  London  Hospital.  A  pallid  iiurse-Lfirl  was  an  out-patient 


every  oiuuhination   of   iron  with  tonics,  made  no  pro'jre.---.      »)•,.., 

",•<>!![-•   through     tin-     wards,    there   wa.-   MiV    illtractahie     patient 

on  I'amouslv  in  lied  mi  the  nrdmarv  chalvhcate  mixture.  So  !"'.j  a- 
she  wa-  doini;-  her  work  fating  her  cake-  she  made  no  pro- •-,...; 
as  >oon  as  .-lit-  was  placed  a!  rest  in  hcd  the  l"»lv  e\p.'nd;tniv  ;'•'.'. 
In-low  thr  hodv  income,  ain!  impro\  ement  hecaiue  |iossih!r. 

\\  liciT  tiic  assinuhltivc  ]HI\VCI--  arc  I't-clilc  n  is  <>\  i\«  u~.'  in  |.i-ur 
in  lilicral  i|uantitic<  n!'  animal  funil.  It  is  not  wliai  i  .-\v;d!n\si-d 
lint  what  is  dii:rstcil  that  iri\vs  stn-n^th.  Animal  lu'utiis  (••Miitrrii,, 
111^'  sniiic  of  the  muscular  :il>rr)  with  sunn-  t'arinai'ciius  ma!"i'.:i'.-. 
often  all  the  liettef  :t'  |ii'e\'inu.-lv  rcmicn-d  snltiblt',  mu-i  aiti  rnaii' 
with  meat.  As  inipp'Vrmrnt  troes  on  the  dietar\  mav  !>e  made  n.'.re 
lilieral.  A  'jreat  matter  is  not  to  over-run  the  powers,  and  hase  ;,> 
turn  hai'k  and  >tai't  airaiit.  \\hene\ir  the  tongue  i<  seen  to  !.e 
covered  with  a  iu-own  fur  then  the  eliaivheati- must  he  withdrawn 
till  the  inutile  clean?:  wlieii  i!  mav  lie  iv-nmed  in  smali  '.nan'.!  es 
and  its  I'H'ccts  carefully  watched.  1  lowever  anxious  in  i;-et  on.  care 
aiiii  caul. on  must  lie  |n-ai-t ised.  In  simjili1  aiia-mia  after  the  iir~t 
slow  initial  |iro^i-e-<  it  hccoiiies  |ios.-ih]e  to  |.ush  on  with  I 'literal 
sn  |>|>1  y  of  fund.  containiiiLT  a  fair  pro  IK  >>;\  '•>  m  of  meat .  eomhiiied  with 
fresh  a:r  and  exercise.  A  waik  sliouid  |tri'ccde  the  iioont  ;»le  meal, 
whieh  should  he  !'(•', lowed  li\-  an  hour  nn  the  .-ufa  or  couch:  and  : f 
sleeli  can  then  he  secured  all  the  hettef.  After  that  a  wash,  a  I'.nie 
of  sonietliinu1  to  eat.  and  then  another  waik.  drive,  or  ride.  P>\  such 
mean-  the  assimilative  processes  are  encouraged  and  aided.  A  ^<"id 
,-u  pplv  of  oxyu'en  rcmoviiiu-  waste  matter-  i-  often  verv  servieeaiilc. 
I  have  known  very  judicious  ti'eatmen;  of  ana-m:a  fail  to  alia  n  the 
»!e>;red  ;ind  wonted  results  on  aci-ounl  of  a  ha^ilv  \eiir, i:iiv 
room;  removal  in  a  more  desirahle  liedi-liamher  he.ni:  at  "ii 
lowed  !i\-  ini]irovement  in  the  patient's  condition,  and  >al  >;;'i'M*|3j 

progress   IlKI'le. 

Another     [Idillt      i-     to     keep     the     hnWeN     npell.         (If     n;d      p!'\~i 

were  verv  careful  to  enmhine  ehalvlii-ate-  wit  h  !a\a!:\''~:  ':,• 
aiding  in  the  ah-nrpt  inn  of  ;  he  iron,  tliev  he;d.  Aii'i  •••  • 
c\  [icrieiice  upholds  this  vie\v;  while  at  the  -an.e  t.ine  • 

hoWels   opell    is    to   <f>-\     \-\i\     o  ]'    cerlai.Il     o|Tell-i\e     Ilia!'''!'-     !'••!' 
hv  tile    lower   howel.   which    wliell    I'e-a  h-oi'hi-d    Illlo    the   -y-'-  r 

a  mahirn  and   pernv  n!;,  iiilluein'e  upon  sanuiiiiica:  "'  .       \\    ' 

howel<   a-.-;mi!at  ion    ;-  ever   inn  crfi  ci .      There  'm;:-' 

tion,  el-e    the    ti'ealnient    of   ana  m;a    ;-:  l!iwar:ed..  •; 


It!*')  .MANUAL   OF    ]>1KTKTK'S. 

be  of  a  character  to  keep  the  bowels  open.  Oatmeal  porridge,  dishes 
prepared  from  maize,  vegetables,  fruit,  fresh  and  stewed,  and  meat, 
and  meat  broths,  or  soups.  These  should  all  be  given  according  to 
appetite  and  palate  and  body-wants. 

There  is  a  ditVerence  betwixt  jiiurmia  and  convalescence  from 
acute  disease.  The  latter  is  a  case  of  quickly  down  quickly  up  again 
verv  often.  In  aiui'inia  there  is  more  chronicit  v.  a  slower  fad  tire  of 
the  powers  and  a  slower  recovery.  A  person  regaining  ilesh  and 
blood,  and  with  them,  strength  after  ana-mia.  has  not  the  recupera- 
tive powers  of  a  previously  healthy  and  robust  adult  laid  prostrate 
bvthe  stroke  of  acute  disease.  The  appetite  is  not  so  keen,  the 
digestive  powers  are  not  so  vigorous.  The  regimen  appropriate  for 
the  one  will  not  tit  the  other.  Circumstances  alter  cases.  Certainly! 
And  li^ht  food  of  readily  digestible  character  should  in  each  cast; 
precede  the  solid  meals  which  are  appropriate  later  on.  while  it 
is  almost  needless,  to  say  all  body-outgoings  should  he  reduced  to  u 
minimum.  * 


('ITAPTKi;    XX. 

!••(><)!>    IN    CONSTIPATION    AND    Pi  A  KIM  !<  K A. 

IN  disorders  of  t  he  a  iinentarv  canal  the  dimce  of  fund     -  sear. -c',  \- 
less  important  than  In  affections  of  the  stomach  itself.      Ti;.-  i' i  ,- 

ofleli  .'lliilit'  .-Utliclent  in  produce  i'!'  relie\e  the  i\V»  oppo-if'  con- 
ditions i  if  constipation  ami  diarrlm-a.  Th"  f-ndt-nev  »f  r;<-e  and 
\\'lii';i[i'!i  iliuir  is  to  hind  tin-  l)ii\ve|s;  that  "!'  oatim-ai  \»  opi  n  them. 
\\  here  the  orilinarv  \v!iiic  u  lii'atrn  ln'rail  lni-ks  r,1.  in.-  !i<>\vrN  ii  i< 
fi'iuiil  in  inaiiv  cast's  tiial  rrli'-f  is  at  nin-t-  alT'>r<li-'l  !i\  i-i^m-t  iiii:  t" 

Illl !  M  »i  ((••!,    ii!'     "   \vlliilf    lllr;ii   "     lil'rail,    (.(',.    iil'ca'l    ci  il  il;il  !l!  1  ILf    til'1    \vll'i]i- 

<>]'  I  In1  i-niist  it  iicnis  of  \viicat .  t  lie  lira  n  as  \\v',l  a-  tin-  i-ni'H.      I  >a:  im-ai 


deserve   it.      \VhetinT   t  h  is  act  ion  is  d  ue  t  o  t  he   tai    the-,'   tv.,     forms 
of  farina  contain,  or  not.   mav  n<>!   lie  aHirmed. 

Then  fruit  is  regarded  as  a  laxative,  and    for  inan\  adult-  as  we.; 
as  children,  a  \\<j.  two   or   three    prunes,  or  some  stewed   apple-  are 
enough    to   correct    the    howds   when    correction    i<   re.jiiircd.      This 
ia  \at  ive  etl'ect    of   fruit   mu-t   not    he  confounded    w.th    liie    [nir^at:\e 
con. -eij  uences  of  a  sui'feil  of  unripe,  or  overripe  fruit.      Here  diarrho  a 
i-  Nature's  process    for  :fet  t  inu'  rid    of  a  n  o'Teiid  i  iiu'   ma-s   in    thea.i- 
meiitai'v  canal,  and  is  a  sain  I  a  rv  process.      (  >i\  the  other  ha  nd .  usidei: 
certain    circumstalices,  fruit    is  a  corrective   of  a    loose    -tale   <>i    the 
howois.       In  nrie  case   kno\vn    f>   me.  a  luhous  liiarrh'ea    i     set   up    • 
summer,  \vhii-h  is  corrected  l>v  eat  ini:' a  ipiant  ;t  v  of  fru,;.       1:   \\o:i.d 
seem  t  hat   hv  introducing;'  a  uiiant : t  v  of  vegetal  ile  matter  to  m:  \  \\  .  •  -,\ 
the  |,ij,..  the  compound  ;-  more   toleralile  t"  the  Liwei  than  tin-  • 
eel; ;  ra  i  ed    hiliarv    matPjr.       At    an\'    lime   a   oiiantiU    o!    api'.e-    ( 
and  ail)  will    put  a  stop  to  (his    l>i!iar\   diarrlnea.      Th;-  n--   "f 
i-  almo-i    unknown,  hut    i;    i-    \vorth    h.-arin^   in    n::n'i.      Th" 
l  he.- is    here    put    forward  as  an  e\ pla nat  .on    o :    t-hw    [;;>•;   ss    '  je'    ..•;-, 
lint    can    s.-arcel\    lie  .-aid  to  he  e-t;i!>i;-hed.       A  ••,.•••,,  n    ! 
i-  ac.-,.ptahle  to  the  -ton  a.-'n.  a1  d   t  he  !  >ark    of   i  r>  ••  -     -  >••.'.' 
time-    than    t  ho-e    of    famiin  .     . ' . ,   when    o1. !  \    . 
a\  a;  .a!  lie.       \\  he;,   ha  v  ha-  tier  n  wa-hed    o\  ••:•!  i,  <;(<•  : 
i:\  e  cat ;  •-.  it   ha-  lieen   f.  mud    thai    \\ !  -'na\  in: 


l»',x  MANI'AI.    (  »F    DIKTKTICS. 

were  readilv  taken,  and  that  the  animals  so  fed.  did  better  than 
those  who  u'ot  no  shavings.  A  certain  amount  of  woody  tihre 
in  their  food  seemed  essential  to  their  health.  ("  Fruits  and 
Farinaceu1. ") 

Conlliot  mu;  vie\vs  are  held  about  the  dietarv  of  eonstiltation. 
Some  writers  advise'  avoiding  food  which  will  load  the  bowels  as 
vegetable  parenchyma,  while  others  au'ain  discountenance  such  food. 
'I'hat  the  bran  of  win  at  is  ^ood  there  is  no  doubt.  I5ut  if  thehvpo- 
thesis  put  forward  to  account  for  this.  f.r..  that  l  he  mechanical  ir- 
ritation of  the  brail-seales  excites  the  vermicular  act  ion  of  the  bowels, 
is  true  and  well  founded,  then  it  would  seem  the  bran,  or  much  of 
it  is  not  digested.  Certain  it  is  that  the  coarser  the  Hour  and  the 
more  bran  it  contains  the  better  it  is.  as  has  been  the  experience  of 
sundrv  manners.  And  the  custom  in  \\  estplialia  of  eating  bread 
made  from  unbolt eil  Hour  lias  been  introduced  into  K upland  ( Liebi^) 
with  advantage  to  the  bread-eater.  The  addition  of  treacle  (which 
is  largely  levulose.  or  uncrv.-tallisable  su^ar)  to  brown  bread  is 
credited  witli  increasing  its  aperient,  elVect :  and,  "brown  bread  and 
treacle"  is  in  vo^ue  amongst  the  students  of  tlie  impecunious  class 
whose  sedentary  habits  clo^-  the  act 'HILT  of  their  bowels. 

It  mav  be  .-aid  as  a  broad  rule,  that  [l--h  meat,  and  meat  in- 
fusions have  a  (list  i  ml  tendency  to  keep  the  bowels  open  :  while  milk 
and  farinaceous  matters  tend  to  constipation.  Cheese  lias  a  reputa- 
tion of  its  own  in  this  respect:  while  e^s.  especially  if  hard  boiled, 
also  bind  the  bowel-. 

As  to  the  peculiarities  of  individuals  thev  cannot  lie  discussed 
here.  One  person  i-  potentlv  affected  hv  a  small  i|iiantitv  of  food 
which  in  the  bulk  of  human  beings  l:a-  a  purelv  negative  action. 
For  such  persons  abstention  from  the  articles  which  d  satire c  with 
them  : -  a: I  I  hat  can  lie  advised. 

Th'.i-  -oine  persons  ai'e  readdv  acted  upon  liv  iVint.  especiallv 
fresh  t'r  I.  ever  t  liev  indulge  in  it:  whili-  neai'lv  all  are  all'ected 

liv  I'h  u  hi.  ii  ';  r-:  eat  en  in  .-prin- . 

I'nder  c-i-rtain  c;rcum.-tances  foods  which  ordiuanlv  lend  (o  ]o(d< 
up  the  bowel-,  -et  up  active  purgation.  Thus  milk,  onlinnrilv 
bindiii'j'.  when  the  stomach  i- acid  so  as  to  set  up  excessively  tirm 
curd  .  ts  a  sliarji  iea:  a  nat  ural  ehminanl  |  HMCCSS  \n  -j-ei. 

r;d  of  the  jieccatit  mailer.  In  the  ~;i  ine  \va  \.other  like  ma  1 1  ers  act . 
(>••..  at  the  Leeds  I  >ispen-ary.  a  \\oman  brought  a  child  ill  \\ith 
o-a.  On  beiiiLi'a-ked  what  she  had  iriven.  -lie  replied  -••  Hard 

•   j-     ."     and      Seemed      io     feel      hel'self     decidedly     ill-treated      bv 


I'rovidetlce    ill    that     tile    child    wa-   til'-   Wo|'-e.    and     !:••'     'if     ;"  " 
!]'•!'  I  feat  II  iellt.       Slleh   c  Till  If,    Hll  per  feet    I'.-;  i  -,,'.;-;-    ,  ,'•  .'a:!'  -   II.. 
t!i:l!l     Sullll1.    \\  lio    1'eal  IV    k  ll"W   .-•'  >llle!  ll  l!l'_f    ill'     fund    and     !'•'•:.:._.    II 
tllllik    p"--lhie;    nlilv   iheV   'in   li<>;    cnliie   illt'i  enntart    With    '.'.  . 

Siiii  more  important  i-  tin-  fiHiil.  \vliiT'-  the  o]  iii.  '-;•.-  - 
diarrho'a  is  established.  One  limad  rule  ni:iv  I"-  iai'!  down.  ;•,'.•':  it 
i-  t  hi-:  -  "  SD  lon<_r  as  ainiiia!  hrot  hs  a  IT  permitted.  -  i  1  «>?!•_'  wii!  diar- 
rhiea  !n-  intractahle.  "  A'_ra;n  aii'I  a  '.rain  has  t'hi~  Itfi-n  iiri\''-!i  .  •-,"  a 
sjiikc  int'i  my  nidiKiry.  <  >f  cDiirsi-.  I  have  li-anii-.l  tin-  !-•--  <>M  t'.  >r 
•jnvsr'if:  hut  111  inv  IHKIIIOII  ;is  a  I'misn  Itanl  .  ;'  cutni1-  ut;'!<T  mv  i.u'  re 
in  rases  treat'1'!  hv  otlie]->.  There  is  anvthii!-'  hut  a  ^eti^ra!  ivei  ig- 
nition "f  th's  t'art:  aii'I  few  nf  our  '\::.>al  re-i'li'iit  -  a!  \'i''."ria 
I'ark  Ifn-nita!  have  tmi  t  his  U-SSHU  ;.,  l.-ani.  M"k  \v;;li  !'ai\!ia''e,  ,us 
niatiei's.  fiinns  t!ie  i'niiil  in  iliarrlina!  i-oiiiiit  i"ii-.  Arp'UT'Mit  .  ir;t\v) 
i--  the  I'IXM!  eui'e  t'u]'  1  1  iai'i'liira  anioii(_r  rhiMren.  in  the  utiiniu!!  »\' 
linti-h  mothers,  Stat'eh  certaiiilv  snittlics  tiie  aluiieritai'v  '-aria!. 
aii'i  a  -a'j'i.  ni'eveii  lietter,  a  taiiinea  |iii'!ii:!i'_r.  t'"fiii~  suft  ua-i'i  ',rj 
fur  a  :">\ve;  \vith  an  irr:;a'>:e  iniic'nis  meniliraiie.  A,!  hari.  ;rr.!ant 
matter  i-  uhjeetinnahle.  ainl  a^i;Ta\  ate-  the  mmi'ii  :<IM.  A  liiari'lm  a 


(if  hari!  potato,  »r  nf  earmt.  of  a  irreeii  staik.  or  a  t>  ere  uf  nti'  .....  i\'-'l 
ceierv;    <>r  of  an  unripe  apple:    anil  i~  eerlainU  a^'^ra  \atnl    !.\   -::  -h 
nieehaniral  irrnant  -.      .Mnk  lioile.]  \v',:h  ri'-e  i  '•"•-;  >j:\-<>\\  ti'i  )  l:a~  a  .';  -- 
t  iin-t  eiirreet  ive  aet  ion.      Milk  \\ith    liiseuit   piiu-iler  i-  e\.->  lien;.      I'.. 
sii'-li  admixture,   tun   linn   rui'iHinLT   i~   avui'ieil.      T"    pu!    :n   a    '. 
cinnamon  cassia  is  to  au<!  a  flavouring  a^'ent   \\  h  ;«-ii  at  t  lie  -a  me  •  •!;•• 
i-  a  'jooil   a'lilitioii   as  acting    favonrahlv  on    lim^e    Im'.ve!-.       In    !•  •:  a 
tli"  fruit    of   the  |',ae!  or  Bcniral  iniince  (A^le  Marma'."-) 
repute  for  the  Ireatineiit   nf  iliari'lio-a.      A1   the  -a  me  tini'-.  ::  :• 
in  cun.-t  ipat  imi.      "  It    is  an    ineomprehen-:!i,e    reine'i\.  ha-    !.)••:' 
aroma  imr  la-te.  aii'l  eertaiulv  HO  astrinu'enev."     ((  'hr>l;-'":.  i     x' 
it   liea  ;•-•  a  L"O'  .'I  I'eputa!  ion. 

Al!  V'/etalil"  aiji    I'm;'  juires   enMain;:;^  !an,!;,n.  are   :  '  '. 

Til-1  ari.rn  and  the  clie~t!  m.  when  dried  and  L:'''"'.::  '•.  tjj&K 
uliieh    has   (li>tinctlv   a-t  r.  i  I'j'eii  t    proper!  ;'••-.       A    Lf'Sffl    | 
from  t  h'  'in.  or  a  n  int'n  -:i>n.      (  Miehcika  ll'ee,  ) 

!  n   acute  d  :a  rrho  a    t  he   !>e-t    f  .....  1    i~    m!!k    \\  ':  h  •  .    •  '" 

\\'  ia  -at  i  •!!  I!'''.  ir  (\\'iih    cinnamon)  in  sma   ,    >.!;a'.'   ' 
1  1  "i    '.I.  d   nor  ton  warm.       M  ;ll\-pudd  in-j'*    mad. 

or  ta  pio.-a.  ai'e  'j;  .....  1.      *  >r.  \><  iwden-d  a  rr>  .w  r  '  I 

in  in.  !          1  1'  sueii  TO.  >d  lie  i  ier-i-!  «-d  w;:  h,  ma: 


170  MANTAL    OF    DIKTKTICS. 

without  calling  in  the  aid  of  strictly  medicinal  agents,  liut  fre- 
quently these  last  arc  indispensable. 

In  more  chronic  conditions  of  looseness  of  the  bowels,  milk  and 
farinaceous  foods  are  still  to  lie  made  the  staple-  of  the  dietary.  St  ill' 
puddings,  as  suet  dumpling  and  plum  puddings,  are  held  to  lie  con- 
stipating, anil  thesa.me  is  said  of  pastry:  but  if  such  is  really  the 
case,  certainly  ne.ther  ai'e  smtahle  for  conditions  of  intestinal  irri- 
tability, whether  catarrhal  or  otherwise.  In  chronic  conditions  of 
diiirrlui'iil  character,  some  olijection  lies  against  annual  liroths  and 
meat  infusions;  and  it  is  well  to  give  them,  or  soups  with  sa^'o. 
biscuit-powder  or  vermicelli. 

Creeled  rice  is  a  very  good  food  in  such  conditions;  and  t  he  juice 
of  cranberries  is  useful,  as  there  is  some  Astringent  (tannic)  in  cran- 
berries. The  juice  df  the  pomegranate  is  also  pleasant  and  good  in 

ailY   looseness  of  the  bowels. 

Then  come  the  astringent  wines,  rich  in  tannin — -as  Claret. 
Carlowit/  and  Catawki.  These  maybe  drank  undiluted;  or  mav 
be  made  into  a  nutrient  food  bv  adding  them  to  solutions  of  urape 
or  cane  sugar,  or  even  to  lactated  foods.  In  many  cases  the  small 
amount  of  alcohol  is  desirable. 

Ii  mav  be  laid  down  as  a  rule,  that  farinaceous  matter  is  useful 
in  diarrluea:  the  soft  starch  being  not  only  non-irritant,  but  actually 
soothing  to  the  morbid  mucous  membrane  of  the  bowel. 

No  doubt  in  manv  cases  of  diarrlura.  acute  or  chronic — just  as 
in  constipation  the  resort  to  medicinal  agents  is  often  necessary. 
liut.  Lrrant  in;/  t  his  and  admitting  the  numerous  remedies  in  our  pos- 
session for  tlie  relief  of  both  conditions,  still,  their  action  can  be 
potently  aided  or  thwarted  bv  a  suitable  dietetic  regimen.  Indeed, 
in  the  milder  cases,  regulation  of  the  dietary  is  sullicieiit  to  keep 
the  bowels  in  a  satisfactory  condition. 

In  the  diarrhiea  which    belongs  to  travelling,  it   is  well    to   take  a 

ose   of    rhubarb      whieh  iir-t    opens  the  bowels,  and    then  locks 

them  up  as  a  secondary  action— the  dav  before  travelling':   and  after 

this  to  take  n  i:l  k  and  farinaceous  mat ters  only  till  the  journey  is  over. 

(In  consequence  of  tin.-  second  a  rv  binding  action  of  rhubarb,  an 
art  ;  tie ia  1  const  i pat  ion  is  fa  r  from  uncommon.  |5v  sub.-t  it  ut  in;x  sonic 
other  aperient  for  the  rhubarb  for  a  time,  the  bowels  commonly 
come  to  move  naturally  and  of  themselves.  Rhubarb  is  indeed  of 
all  aperients  that  least  lilted  for  habitual  use.) 


CIIAI'TKI!    XXI. 

F<HH>  IN   PHTHISIS. 

\\  A --TIM;  disease  is  eon.-iim !>t:<'M.  wh.'-n    mav  IT  niav  not  h»-  pui- 

nmnary.       Of    (,](1   this  was  Spoken  of    a-  a    "  weariv_r  "    '.•..:!    w.  a:\nif 
out.  or  exhaust  imi    of   thehodiiv  \>»\\<T-  vvitli    emaciation.      \\  :.••:.  a 
jiersuii  was   spoken   of  MS   "  liriir_r  in  :i  i-on-umpt:o:i."  :t    meant    i:.a- 
In1  or  she  ua-   emaciating:    hut  ii;d  \\<>'   !n\"'i!\«'  an\'  -i"-'-:,-il    iviii-'-  I'ui' 
tin1   wasting.       I  >;•.  ( '.    15.   \Viiiiam-    h"j  -    that    phtiil-]       -   'he   u-ua! 
niala'iv  w,;h    persons  who  il;e   "  In-iik'-ii-hi-art'-'i."      N'nw  liif  :••-!:;  ;-• 
almost    entirely    re«trieti-il    to    pninninai-N-    plith,-i~.    ot-   ••  i.ii'Ji        '. ." 
Th:-~  pi'iniit ;  ve  eoneept  ion  <>\  "  i-oiisii nipt  ion  "  <>r  "  -,\  .;•••!::..•." 
worth   lu-arin.ir  in  iniinl  in  relation  to  ph;  h'-'~:    \\  :  '  -ii   ;;-    :;;.>  pri--.'!;: 
<lav  is  ton  exi-lnsivelv  rr^ii  ri  in  1  as  a   inei'e  local    n.n.a'iv  •<''   :!n-  .  ;:._." 
In  realit  v  jHilinonarv  plithisi.s  i-    -as  a  rn'i-      '  .11:  a  .  » 'a    I'Mu-c^inn 
of   a  '^i-nrral   wiiiespreail    alpl    eon-t ;;  u!  iojia!  '-,.;;  '.'.;'.,, :,:     a!1  i   !-h.-  '.'    : 
•\\-lii'1]!  nin-t    I)'1   kept    wrll    in    si^'ht     in    al!    treatnu1!;.  p!--\  ••'.:  :\  ••    o;- 
cu  rat  i  vi'.      The  very  1'aet  that  i:   run-  in  err:  a  in  !'ai :::;  i-  •-  \\  hii.  •,.••.. 
ai1''   euuallv  exempt    from  it,  i<   a    ino.-t    -M'J'L  c-~'.  .\  <•  fa 'i.      \\  • 
linki'ij  with  (iisease  of  the  ^iainl-  an-l  scroll-  nicin'iran''-.        1' 
hooil  we  li'i'l  the  hidden  taint  shewing  ii-e'f  in  lii-'ra-e  i,f  ;h,.  m,. 
terie   glands,  "  pot-helly."  or  'I',*!,  <    1A  -  •/.•    a:i>        \  in1 

meningitis,  otherwise  :ieiite    livdroeephaiu-.      A-    \eai'~   a'isa:.'1" 
find   the    ti'iidetiey  to  disease  in   tliese  area-  Lfi\e  wav  to  -•;••;!:.";;-.  .••. 
lai'Li'emeiit    of    liieu'lands    of    the    neek.    and    d:-ea-e  mt 

Serot'idosis   and    t  nliereiilosis  av   as   nearly  related    a-    i\\:::-.  a 
not  inerelv  have  the   same  pai'enta^e.       In  the  piv-i-n;  >  -\\   v 
attention  ha-  rieeii    so   stroiiiriv  di'awn  to   ij;. 
are    found    with    pnlmonar\    phthi-is    we  are  a'.''    :•'    l»-e 
eon.-t  .tut  ,onal  rehtt  ions— it-    niori.id    k:ih    and  i\.n.      T 


I  ,  L'  MANUAL    OF    D1KTKTICS. 

resistive  power  to  the  tubercle  bacilli  inspired  h\-  all;"  or  to  state  it 
thus — "Certain  families  manifest  a  U'lulenev  to  lung-changes  in 
which  the  tuherele  bacilli  lind  a  t'avouraltle  nidus;  "  we  must  con- 
front the  t'aet  that  there  is  a  something  in  some  families  which  ren- 
ders its  members  liable  to  become  phthisical,  which  is  not  present, 
;:i  other  families.  Taking  a  broad  view  of  phthisis,  it  can  be  hon- 
est 1  v  atTirmed  that  the  families  which  exhibit  this  tendency  to  tuber- 
culosis are  those  in  whom  the  st  ruinous  dial  hesis  is  existent.  It  is 
the  "lowlv  ethnic  form."  which  carries  with  it  the  tendencv  to 
tissue-degradation,  which  gives  us  our  phthisical  families. 

Laennec  laid  it  down  that  tubercle  was  a  neoplasm --a  new  in'owt  h 
of  tissue. — unknown  in  the  healthy  organism:  and  when  it  was  found 
the  case  was  hopeless.  To  such  d ismal  view  has  succeeded  another 
and  truer  one.  viz.  that  there  is  nothing  in  tubercle — no  histological 
element-  -not  found  under  other  circumstances.  Tubercle  is  a  rapid 
proliferation  of  connective-tissue  corpuscles — the  lowlv  basement- 
membrane.  or  packing  material  of  the  body — the  more  rapid  and 
excessive  the  production,  the  more  huddled  together  the  cells,  the 
more  liable  is  the  mass  to  die.  The  sparser  the  production  and  the, 
nearer  the,  new  growth  to  normal  tissue;  the  better  its  chance  of 
survival. 

This  pathological  disquisition  is  not  the  pursuit  of  a,  side-issue  of 


Lfrasp  if  he.  or  she,  is  to  have  a  correct  and  vigorous  hold  of  the 
dietetic  management,  of  phthisis.  \Yhen  the  ceil  growth  is  rapid 
ami  extensive,  the  crowding  of  the  individual  cells  upon  each  other 
means  deal  h  to  them.  It  is  like  crowding  a  host  of  individuals  upon 
a  Smiled  area  so  closely  that  it  is  impossible  to  feed  them:  those  in 
the  centre  die  first  from  starvation.  Rokitanski  speaks  of  this 
"central  softening'"  and  of  "the  ocular  proof  that  the  softening 
commences  at  the  point  most  remote  from  surrounding  textures'' 
i;i  i  ubercle.  Such  so  ft  en  i  n 'j  or  ca  scat  ion  of  t  he  muss  is  accompanied 
bv  hectic  fever  wlii'di  mav.  or  mav  not  exhaust  the  powers;  and 
wear  the  patient  out  m  a  shorter,  or  longer  time  according  to  cir- 
cumstances. If  the  softened  ma-s  can  be  expectorated  a  cavity  re- 
mains, which  mav  include  the  whole  morbid  area.  leaving  the  in- 
dividiial  short  of  so  much  lung,  but  otherwise  little  the  woive.  At 

nlher   times    i: vpectoration    of    the    softened    tubercle    i-  acroni- 

!.  Hi-  fo'. lowed  b\-  a  new  development  of  tubercular  n'l'owt  h 
doonie  ;  ;,,  Joficii  and  die:  and  the  IOIIL;'  continuance  of  the  hectic 
f<  ••:•••••.  haust-  the  powers. 


Hut  tin1   course   run    is    not    :il\v;ivs    -o   L.r'""iuv.      Th--   tv 

growth    mav   Hot     lie    so     five    ;i:ii!     tin-    ceils    <!n     M"t     crowd     •   ;...;,    .,•. 

another  so  liercclv.  and   .-o  some   nutrition   of   tin-   new  •_'•:•< iv,  • : 
lie    po--;l>ie;    in    which   case  death  d»e>    M.,;    fo'i'nv.      "  Va- • 
in   truth,   beloni:-;   as    little  tothe    nature   of    t  uin  •••.•!>•  a-  or-.-,:., 
it  -ell'  "  (  le>k  itansk  i ).       I  Jut   if  enough  of  nut  rit  ion  can  1  "•  a:v<  >rc..'d  !o 
the  mass  of    lowlv  texture  it   inav  niaintain    life,  at.d,    wither  u;i.       !:. 
some  cases  only  a  ma-.-  of   lime  salts  (like  a  piece  of  m"rtarl  <vma:!;- 
to    tell   of   the    hv-]);ist    tuliercle;    which    mav  Mav  in  \  /".  or   h.-  ,  \ 
]iector;ited  IOULT  after  al  1  evidence-  of  in  n^  mi -eh  icf  ha\  e  pa-sed  a\\  av. 
Such   is  the   hi.-!orv  of    tuliercle.        I  Jut    what   does  the   eminent    path'i- 
lo^'ist    tell    us!'-— "The  cure   of   tubercle    mav  take    pla-'e    in  \ar:"i- 

wavs.        l-'.ach   of  the   Ilictliniorjilioses  of   tubercle   ma\'  heconie   ill\c-l«'d 

wit  h  t  he  e!i;ir:ieter  of  a  healing  process.  Mill,  neither  I  he  decadence 
of  tuliercle.  nor  its  ejection  ihroiiLi'ii  the  meilium  of  ulci-rat  [»:;.  a- 
local  heal  in1-:  processes,  ai'e  fraiiii'lit  \\  it  h  an  v  value  for  ;  he  indi\  id  ua  . 
n  n!  c-s  a  c  con  i  pan  led  hv  the  extinct  ;on  o!  i  he  t  undai  iient  al  i  u '  "•!•.•'• 
producing  era-is. "  This  is  the  uTeat  matter  to  attaiii  if  po->il/.c. 
Opinions  ilill'er  as  to  when  the  term  "tubercular  "  can  be  applied  to 
the  mi-chief  in  the  liuiu'.  Some  hold  i!  max  be  n-ed  when  i-oiiso1,;- 
dalton  of  t  he  Iniiu'  is  on  foot :  and  in  cei'tain  case-  this  is  so.  as  when 
luiii:  consolidation  is  found  in  a  person  of  tubercular  familv  hist"rv 
who  has  been  wastini;'  for  sonic  time  and  had  ii:i;h!  sweats.  <>'!:'•;•- 
hold  that  a  mere  consolidation  of  the  lunirs  is  not  enough,  and,  thai 
it  is  onlv  wiieii  there  is  evidence  of  softening  o;i  f"o:  there.!,  iha: 
the  term  '"  tuberculous  "  ean  be  trnlv  appl  eil.  In  the  lan^ua^e  of 
Xieiuever  ''  we  have  no  hesitation  in  stating  that  the  ^reate.-t  dai^'er 
for  the  majority  of  consumptives  is  ///"/  lh<  >/  nr<  "/</  fn  f»  >  < 

I'  II  1(1  IIS,  " 

He  >avs  too — "  Prophylaxis  a^ain.-t    consumption    require-  ii;  tin 
iirst  place,  tliat   when   an    individual    show.-  si'-rns   of  defectivi'  \\\\'.r' 
lion  and  a  delicate   constitution,  i-speeially  if    he  have   L:":\CM    p..-: 
evidence  of  niilHlial  delicacy  wil  h  a  tendency  to  di-i-ase.- 

in    eaSCOllS    product-,    //''    slinlllll    //»•   /i:ih-,il     //     y/n.v>//;//  ,     // 
rillriiLi!,',!  In   i ,,  I'i  ijui'U  t<<    UK'  n))l*t  i  I  H 1 1»  it .    "/"/    '"  f.<  t  <  >i  <l  n  i  *!, 

1,1,1  1^,1,  „,•,,." 

The  proph  vlact  ic  treatment    of  tubercular  alTection-  .if  a!! 
i<  to  prevent,  or  remove   that  dvsera^i-'.  or  general  con.!  -  :.of;   <•' 
bodv   and    its    tissues   winch    Drives    the    ti'in:cn,'v 
degraded  connective  tissue  corpii.-cle-      joo  'ow!\.  : 
or  urbanised  iu  live.      There  i-  a  L:v:'.'Ta', 


171  MAM'AI,    OF    DIKTKTICS. 

tlir  inherited  constitution  is  a  ^ivat  matter.      F.vd  surround incfs  ;m<l 

tin-  mode  of  life  tell  mi  the  parent-organisms,  and  what  is  acquired 
bv  the  parent  becomes  inlicritcil  l>v  the  chiM.  l.im'ol  said  the 
population  <>!'  Pans  of  his  day  was  eaten  up  hv  scrofulosi-:.  vet  their 
ancestors  three  or  foui1  generations  hack  \veri'  liealt  hy  people  from 
the  eountrv.  I  >r.  \\alshe.  and  still  more  receiitlv  .lames  Cantlie 
have  pitinted  "lit  the  degeneracy  (»f  the  populations  <pf  !ar_ro  towns. 
VOL:V!  savs  "''hildivn  hriii";  no  existing  tubercles  into  the  world 
with  them."  though  "  there  is  no  disease  so  positive! v  inheritalile  as 
tuberculosis. "  <  i  rant  m.'j.'  this  he  i^oes  on  to  sa  v—  "  The  following  arc; 
U'enera'dy  considered  the  external  causations  of  tuhereulosis;  had 
air.  eontinemeiii  in  elose.  imperfeetlv  ventilated,  dustv  moms,  damp 
hdise- and  had  food  hv  which  living  exclusivelv  on  rve  l>read  and 
potatoes,  and  the  deprivation  of  animal  fooil,  is  understood." 

\\  ith  the  oilier  matters  than  hail  food  we  cannot  deal  here;  hut 
with  it  we  can  deal  to  some  purpose.  If  the  tendency  he  a  matter 
of  inheritance  let  the  phvs;eal  links  hetwixt  parent  and  oitVprinil  he 
severed  as  soon  as  mav  he.  The  mother  should  irive  place  to  a 
healthv  wet  nurse  (chosen  on  lines  and  principles  laid  down  he  fore). 
In  households  win-re  this  cannot  be  accomplished  artificial  feeding 
must  he  whollv  or  partlv  carried  out.  In  the  matter  of  struma 
insistence  was  laid  upon  the  nccessitv  for  fat  for  the  formation  of 
sound  healthy  tissue.  Phthisis  is  an  outcome  of  t  he  st  ruinous  ha  hit ; 
and  to  improve  the  strumoiis  hahit  is  to  reduce  the  nsk  of  phthisis. 

Kat  is  re(|iiisite  for  t  he  huildinir  of  heal!  hv  tissue-elements.  Milk 
Lfivesthat  form  of  fat  which  is  most  desirable.  \\y..  :  -t  he  emulsion. 
I-'at  in  milk  exists  in  a  very  line  emulsion,  the  fai-u'lobule  beinn  verv 
Milk  is  mo-'t  acceptalile  to  all  VOUUL:'  ei'eatures,  and  is 


as  to  iiu-lude  a  Muantitv  of  I'at-liearni'j;  milk.  TO  this  mav  lie  added 
some  prediLTested  starch  if  needful.  I  Jut  as  soon  as  the  infant  can 
chew,  and  ha-  some  organs  of  ma-tication  i!  hei'omes  a  iMiestion 

how    far    '        not    -• 1    poliev  to   LTJve   it    some  food  on  which    ;t    can 

exercise  IN  jaws.      A  biscuit,  or  eracker,  or  piece  nf   hrea'l  munched 

would  lead    to   thirst  calling   for  a   draught    of  mdk.      Siii'h   starchv 

matte!-    \\->  i      <•'!   would    develop   the    jaws   and    their   aecessori«is. 

Too  much    si » ft   food,  whether  of  insoluble,  or  of  prediufestcd  starch. 

leaves   out    of    ~i'_dil    the    natural    mean-   of   developing   the   salivarv 

Is.      Th'1   LrnawiiiLT   which   a    child    delights   in    is  started    hv  the 

• '.«'.,  set   up  by  the  teet  h  con  i  i  1 1 '_;'  1 1 1 H '  1 1  -'!  i  the  i,rum.       I  hirinir  t  h" 

time  of  the  growth  of  the  primary  ij\-  milk  teeth  this  irritat  ion 


OXHtS  and    serves  an    IIS. -fill     plirpo-c.        '\\<    rciii-ve    1'.    tile, 

sonict  hinLr.  :iii  ivorv  or  india-rnhher    mi'/;,  "''  pad:    th-1 
run-  down  11  -  In!)  tcl  hie1;  of  t  he  ad  ivit  v  "!'  tin-  -a , ,  \  ar 

;lc!  ;\  e  ll|o\  ellient   of  the  jaws         If   t  il<J   I  lit';  Hi:    c(1;t!d    he  ".i 

;i   p!c,-e  of    hread  or  hiscuit.   il   wouid    he  \vr,i.       \<>  douo1     \ 

di'jv-:  :«:i  is  active  in  early  life,  and  salivarv  a. -linn  •  •  >inc-  into  i.!..--a- 

lioii  w;;h  ma-t  i'-;i  I  ;i  >>,\.       Aiiinial<    \\'!i:'-h  rln-w  thc'r   'Mi'i    art-  11  •'   -:>'.'•• 

from    t iiliiM'i-ulosi-'  ( to  \vlii. 'h    nxi'it   arc   c'-rtaiiilv  sn'if'-ri  I.       I'.  ;•    :ii.- 

cvcri'i-c  nf   ilic-jau'<    is   ^UM,!  for  ilic   ili'vi'lnimn-iit    <>\    tin-   ni-^a:!-   "f 

;ii-alivation :    aii'l    tin1   iliasta-i'  u'lii'-ii    tin1   -aiiva  cuntaiiN  :!•••-  uo«>n 

t  in1  stan-h.      ('hinlrt'ii    \vin>  irna\v  at  a  cm-:    arc  ilmiiLf  a  ^ i    t!r.:ij.' 

f"r  the  ilrvcIojiMHMit  of  their  ja\vs,  ;nnl  \vit!i  that  tin-i!1  j 'cniia'i'-Ji' 
teeth;  ;in'l  a!-n  hrin^ii'iLT  out  their  ,-alivarv  ^'lain!-.  Arnl  iijmn  ::i- 
sa'nvarv  iii'^e.-tiuii  their  life  or  death  mav  turn  MI  me  I'litiu-e  :':t\-. 
Surplu-  .-uir.'ii'  i>  storeil  as  fat ;  \vherestarcii  ili^^tioM  ;-  ':••!'•  -<-\  :•••• 
ciuaciat  Mil  set  -  in. 

Tin-  >i  i  ft  fnoil  -i)  much  ^iven  \»  eln'nlivM  niav  he  in  maiiv  ca--i'-  a 
inat'er  unavoidalile:  hut  in  mir  ile<;re  to  feed  the  eh;M  ,n  ;!ic 
present.  <!••  not  let  us  prejudice  it-  future.  Tin-  eiicmtra^enien;  uf 
the  saliva rv  u'lai ids  hecomes  then  <>\'  importance  ;n  the  die;";.c-  .,;' 
i'liildreii  who  have  a  tuhetvttlar  i'arnilv  histnrv. 

Then  t  lie  re  i-  a  not  her  point  to  he  at  t  cm  led  '".and  i!  i-  t  it;-,  \  '.,•:.  : 
— the  ah-encc  ,,f  f;|t  in  mailed  prejiaration-  or  haked  llmir-.  A'i- 
inirahle  as  Mellin's  food  is  as  an  addition  to  milk,  it  can  no'  |d,esp.:e 
(he  advertisement)  take  the  place  of  milk.  1:  lack-  the  c--,-n!.al 

factor — fat.      The  same  ohject ion  doe-  not   he  aLi'ain-i   l:i'-:a!'-d  i' i-. 

win-re   milk   enters   into   the  eomposit  ion   of   the!' 1,  or  wh.eiv   tip- 

yolks  of  c---  arc  us,.,].      The  hread  should  he  huttcivd.  or 
used.      Some    iu-lv  fellows   have    heen    rai.-cd  mi  a  dn-tarv  cn:.-.-i  m^- 
of  nothing'  more  than  a  lump   of    hread  and  some   dr;ppi:iL.r.  <>'.'  I  h  ' 
of  hacon.  •  The  hread  should   he  cut   thin  and  tin-  hint"!1  weii 

in  for  delicate  children.      \\'here  the  u-ual  fan  v  f 1-  arc  : 

taken   t  lien  of  course   resort    to   cod    liver   o;i    h^rom, - 

The  .-i -ant  v  rat  ions  of  man  v  a  1  it  t  !e  mile  are  el<i'd  out  \>\ 

oil  from  t  he  hospital  or  t  he  dispensary.      1  !•••  mem '..•:•  a  .-a-- 

Soiue  eiiiplovci-s   at     l.eeds.    went    oir    on    -trik«- 

plo-.-i-r-.   an-l    had    to    "  i-Ii-m  "    (starve)    in    con-'-.j-M.-ii''.-..      M 

cmaciaiei]  child    was  suckled    l>v  it-    ninth"!1    wi  o  o1    \ 

little  \vak  tea  and  drv  hread.       Mverv  ari  :cle  of  : 

pos-sihlv  he    -pared,   had  pine    to    the    "  hoii-c 

halls. "      s^  line  cod    liver  uil    and    si  eel    wine    !  mv, 


1  t»>  M  \\r.\l.    OK    DIKTKTICS. 

wonders  for  that  lit  tie  starveling.  It  is  not  uncommon  in  the  Xorth 
of  .Knijfland  to  see  a  child  fcil  on  pap  for  its  meals  with  a  little  l>a,u' 
to  suck  or  chew  betwixt  meals,  containing  butter  and  su<^ar,  called  a 
"  sno-ar-pap."  'I'his  is  a  capital  plan  when  milk  cannot  be  obtained, 
and  supplier  an  excellent  form  of  fat.  The  utilitv  of  ordinarv 
totl'ee.  as  an  admixture  of  carbo-hvdrates  with  hvdro-carbons  pos- 
sessing a  liiu'ii  nutritive  value,  has  been  pointed  out  before. 

Such  then  are  the  various  modes  of  introducing  fat  into  the 
vouthfiil  organism.  There  remains  the  inunction  of  fat  to  fall  back 
upon. 

Then  most  authorities  advocate  a  supply  of  irood  vegetables  for 
children  —  not  in  lieu  of.  but. — in  addition  to  other  food.  These 
supplv  phosphate  of  soda  and  other  useful  salts.  The  same  end 
m;e-ht  be  met  bv  animal  food,  if  it  were  not  for  the  fact  that  in 
children  of  strumous  or  tubercular  constitution,  thev  are  </i\'en  to 
the  formation  of  uric  acid  in  larger  quantities.  Potash,  a  uric  acid 
solvent,  is  advocated  by  all  authorities  on  tuberculosis  or  scrofulosis.* 
Phosphates  must  be  supplied  freely  to  children  of  this  diathesis,  as 
tliev  readily  escape  bv  the  urine;  and.  of  course,  if  voided  in  the 
urine,  are  not  available  for  the  tissues  where  thev  are  so  needed. 
\\ell-eooked  vegetables  should  be  allowed — and  form  part  of  the 
dietary.  For  the  supplv  of  other  salts,  as  the  eit  ratc-malate.  or  tar- 
trate  of  potash,  for  instance,  fruit  in  various  forms  should  not  be 
forbidden:  indeed,  the  eating  of  ir  should  be  distinctly  encouraged. 

A  heaithv  child  can  extract  what  its  svstem  needs  from  verv  un- 
promisini:  materials;  but  not  the  child  which  comes  into  the  world 
with  an  impaired  physique.  It  mav  not  brinir  with  it  into  the  world 
ready-formed  tubercles;  but  it  brings  with  it  the  tendency  to  their 
formation.  And  with  a  thorough  knowledge  of  this  fact,  we  must 
do  our  h".-i  to  condiHt  the  inliorn  tendency. 

Tlie  milk  of  the  Alderney  cow  is  best.  Then  that  of*  t  he  black- 
polled  An^us  breed;  but  the  milk  of  any  healthy,  properly  fed  cow 

•;:  There  is  a  curious  and  interest  in--  point  about  the  forma  lion  of  uric  acid 
hv  children  of  s-t ruinous  or  luliercular  family  liMnrv.  I'rofe-.v,,r  l.avcock 
pointed  out  t  hat  the  -.keletoii  of  t  he  st  ruinous  is  of  ]<iwl  v  et  hnic  form.  I 
have  elsewhere  pointed  oui  |io\v  i  he  formal  ion  of  uric  acid  l>v  a  mammalian 
liver  is  a  i  a^e  ,,f  reversion,  or  turnine;  back  of  the  liver  to  the  form  of 
nil  rou'ciii-ed  \\a-1e  found  in  the  birds  and  reptiles  who  have  a  solid  urine. 
The  mammalia  have  a  llmd  urine,  largely  composed  of  the  soiuhle  urea. 
We  vrc  1  hen.  ill  the  -I  rii  ini  'Us.  o>scous  de_  radat  ion  as  \ve|  ]  a--  he  pat  ic  d<--Ta- 
uli;  liolli  of  \\luch  inu-1  lie  home  in  mind  in  t  heir  d  ietei  ic  regimen. 


FOOD  IN   PHTHISIS.  1  ,  7 

will  <!<>.  Mixed  with  tin-  various  farinaceous  ni:it>-r-  :i-  a  iri'.k 
pudding,  milk  should  be  a  staple  of  the  dietary.  I'.nUer- 

freelv    supplied.       15  read    niiil    butter    pudd  MIL;'   is   L: i.       lJu'i'T   c-:i: 

lie  ;ii  1 1 led   In  milk   pudding  :it   tin-  table  wit  li  ad\  anta-'f.       Kai-ca'    ' 

must  be  encouraged:  and  suet  puddings  an- _LT 1.      The  baked  beans 

and  pork  of  \ew  Kiiii'land  form  a  capital  food,  rich  m  fai.  l'«;.-i:..<- 
.-In  1 11  Id  tic  well  luit  tnvi't ;  and  i'i  >r  a  chanirc,  some  milk  wa  nil-- !  u  , •  ii 
a  knob  of  hlttttT  incited  in  it.euuld  he  served  at  table  with  pia:n 
boiled  potatoes.  I'astrv  made  of  l-'reuch  pail'  pa-te  mav  be  allowed 
(when  it  dors  not  cause  ijidi^i-stion).  in  rea-<mahle  ipiaiit  :t  ;«•-. 

\\'liere     lllc     appetite     1-     eapricioil-.     evell     i  huriilate     el'eaillS     have     a 

\'alue.  Sweets  mav  lif  esseiitiid;  hut  su  far  as  possihle  the  raim^  nf 
sweets  betwixt  meals  .-hniild  he  avoided.  Ii  mav  lie  neces-afv  to  eke 
out  .-mail  lileais  hy  sweets;  hut  a  watclifui  and  evi  n  siispieinii<  eye 
should  he  kept  on  the  practice  in  order  to  avoid  the  emu-  of  spuiliirj' 
the  apjietite  for  meals  hy  sweets.  Indeed  u  H  unlv  in  rare  ea-e-; 
that  the  plan  of  "uiiv  food  rather  than  none."  is  necessitated:  and 


(  >f  course  toll'ee  ( '  'ontai  n  HILT  hut  ter )  is  t  he  he-t  form  of  swi-et :  and  1 
know  at  least  one  eomely  dam-el  who  owes  her  life  to  toll'ee  in  tii-1 
ear!  v  \  ear-  i  >f  pul  icrt  v. 

In  some  of  the  Nort  hern  parts  of  the  I'.S.  A.  a  cure  for  phthisis; 
in  vo^ue  is  to  u'o  Itimherin^  whei-e  pleutv  of  exercise  in  the  open  air. 
t  he  sharp  chill  air  of  wilder,  trives  an  appet  ite  for  fat  pork.  Such 
a  plan  is  only  suited  for  |>!i!  i]i-i<'a!  put  icnts  with  lar^e  and  capahle 
frames.  The  principle  is  sound,  and,  the  practice  mav  !»•  imitated 
in  a  les.s  severe  and  gentler  form,  hv  main  VOIIUL:'  persons  threatened 
hv  phtl;is:s.  1'ientvof  exercise  in  the  open  air.  with  homiuv  and 
pork  for  victuals,  would  save  manv  a  life;  cspeeial'v  ;iuioii^si  ;!iat. 
wretched  ;  own-populal  ion  doomed  to  live  in  small  lil-veiitilated 
apartments,  where  the  air  is  I'mil  and  laden  with  mechanical  irri 
tants;  who  foi'iii  a  lar^'e  proportion  of  the  phth:-ie;il  pa;  ent-  wh.  -h 
ei'owd  the  waitini:'  rooms  of  nl|  hospitals  for  diseases  of  the  che-t. 

And  now  a  few  words  a  ho  ut  the  use  ol'  rod  1  ;\  er  o: !.       A-  p'>;  •;  vd 
out   liefoi'e,   lish-oil   is  no;   the  iiio-t  dcsi ral i'e.  or  the  'nest    form  i'1   fa': 
hut   i;   has  the  ad\anta".v  of  hein^-  the  most  di^'-si  ilt'c.       I'    - 
taken  after  food  :  and  in  order  not  to  needles- !\  provoke  t  he  -  ••:. 

the  interval  should    he  ahnul  an  hour  if   po^-ilije;    ~o  ih;t;   it  ,-ai.  M.. 
with  the  food  passing  out  of  t  he  stomach  n.to  i  he  d  uodeuum.  whe- 

the  digest  Jem   of   f;i|    he^ilis.        A-    pointed    out    before.    !:  . 

fat  does   not  commence  tini  d    ;  he  food    has  l,.i'j  i  ],,.   ~',,\,.,, 


^lAM'AI.    OF    IHKTKTK  S. 

y  if  iriven  before,  the  oil  only  swims  about  the  stomach, 
otl'endiiiLT  it,  and  causing  spasmodic  contractions,  or  excitations. 
Whenever  the  stomach  resents  its  presence,  it  is  we'll  to  administer 
the  oil  at  a  distinct  interval  after  meals.  In  other  cases  it  is  con- 
venient to  take  it  immediately  after  food  (as  in  the  case  of  workiiiij;- 
people  LyoiiiLT  to  their  work),  and  if  it  does  not  disagree  it  mav  ho 
taken  then. 

After  ten  years' experience  at  the  City  of  London  Hospital  for 
Diseases  of  the  Chest,  and  mv  other  experience  at  the  West  London 
Hospital,  and  at  the  Leeds  1'uhlic  Dispensary,  to  sav  nothing  of  over 

L  L 

twentv  years  of  private  practice,  in  the  thirty  years  which  have 
elapsed  since  I  was  hound  apprentice  (as  an  apothecary)  to  mv  father, 
who  was  in  general  practice  in  West  moreland.  I  mav  say  that  in  en- 
counterinu'  phthisis  mv  greatest,  dread  is  a  distaste  for  fat.  \\here 
the  nutrition  is  intod.  the  prognosis  is,  as  a  rule,  favourable;  even 
if  a  larii'e  area  of  lun^  is  implicated.  \Vliile  on  the  other  hand,  in 
those  cases  where  there  is  slowly  progressing  emaciation  with  a  dis- 
taste for  J'at.  tin1  prognosis  is  as  dark  as  Lrchus,  even  before  any 
lun^  complications  set  in:  which  commonly  enough  is  not  till  an 
advanced  stau'e  is  reached.  Whatever  may  have,  been  the  teaching 
of  the  experience  of  others,  that  is  the  lesson  my  experience  has 
taught  me.  When  a  patient  is  steadily  wasting  with  a  tainted  family 
history,  and  a  personal  history  of  a  loathing  of  fat  intensified  of  late, 
then  the  forecast  of  the  future  of  that  patient  presents  no  difficulty; 
it  is.  indeed,  onlv  too  easy  to  tell  what  it  will  lie.  The  practical 
outcome  of  this  i<  the  insistence  of  fat  —  in  sonic  form -— beinir  taken 
without  waiting  for  Innir-iniscliief  to  show  itself.  That,  lock  which 
opportunity  carries  in  front  of  it  (b'sni:'  bald  behind)  must  lie  ener- 
<reticallv  grasped;  and  to  be  forewarned  is  to  be  forearmed.  If  the 
patient  can  be  induced  to  take  fat  for  the  tissues,  all  mav  vet  be 
well.  The  absence  of  tat  (somehow  or  other)  leads  to  a  dvscrasis 
which  favours  the  product  ion  of  tubercular  i!;ro\vtlis.  Kven  when 
tubercle  ha-  developed  and  softened,  cod-liver  oil  has  snatched 
manv  a  patient  from  the  'jravc  —  va  \vnmi:  before  him.  or  her.  If  fat- 
can  lie  take!;  Ill  SllHiclCllt  <  |  lia  lit  It  le<.  llCaltllV  tlS-lle  ea  II  be  built  Up 

around  t  he  di>easfd  area,  and  the  ravaires  of  the  invader  arrested. 
\\  here  the  absence  of  fat  leads  to  a  depraved  t  issne-'_ri'owt  h  and  repair 
for  a  considerable  tune,  then  a  condition  of  much  danger  exists. 
1'rof.  Laveoek  callei]  this  —"the  [iretnliercular  stan'e  of  phfliisis."' 
Anv  tnbcrenlar  !_rrowt h  then  formed  will  certainly  start  on  a  down- 
ward progress  in  the  least  possible  time.  '|')ie  impaii-ed  tissues 


FOOD    !\    I'll TIII^I^.  ;  7;i 

around  it  oll'er  little  resistance,  and  th>'  neeros;n:_:  tuhep-!i!a:'  ma-'s 
\\orks  in  no  time  tin-  ruin  of  the  .  .ivani-m  a.n-adv  -ai>i  [  and 
undermined. 

IM  all  families  where  there  exists  a  tubeivular  ;•  •: 
ilren  ouirht    to  be  taught  (almost  as  a  reii^iou.- du:  vi  !••  ,;'. 

some.  Hi1  ;IMV  i'onii  a<  tin1  ea«-  mav  In-.  'I'..  mv  mind  ;M;I;  , 
inosi  efl'ective  insu  rain  ••  •  against  phthisis  tha;  ran  If  -,\.  ;,,>,•../.  ;• 
is  unwise  ami  .-hort-.-iiriited  to  let  tin-  rm-mv  In-  upon  one,  :  .-:m 
IM-  fcprcseeii.  Iii  sninr  cast's  win-re  coii-iivcr  <>\\  cannot  !"•  ta  \>-:i. 
mutton  surt  rhoppcil  tiin-  ami  boiled  in  milk  secures  tin-  di--::-i'd 
end.  Thi-  |»ian  is  in  ^''i-at  favour  in  Loiiilon.  Imi  exists  i-vi-rvu  in-ri-. 

I'rohahiy  the  mo^t  digest iltle  t'at  next  I"  i-n-l-Iiver  oil  is  ill.-  ii-jnal 
fat  of  j'rir.i  hacitti.  Tin-  rardv  up-ds  tip1  siojiiacli.  Iliva'i  frum- 
lilc'i  ihtu  the  fat  eiiatiieM  it  to  lie  ivaililv  taken.  «>th'-rs  like  fa; 
liaenji  hoilcil.  anii  samhvielies  ma-le  therewith. 

SIP  iiiiii-h  I'm1  the  feeding:  of  the  pi'tentia! '.  v  phthisieal.  ai.'l  \vhaf 
I'i'rm-  of  I'IMI,  1  <iu-'!it  to  lie  taken  !>v  them.  N'ou  soinet hintr  mav  '•"• 

Sli'l     i'f    ill'1    feeding    nf    the    sick    consumptive,    Wlleiv    the    appetite   is 

feehle   and    ea pi'ie ious,    and    the  digestive    powei'   weak.      Sum.-    ! ;' 

tea  with  Kidire's  food,  or  like  foud.  a  ^!ass  of  milk  \\itli  snme 
Meilin's  nr  other  lik'-  fomi  in  it  :  or  sonn-  malt  extract  witli  an 
aerated  water;  a  vulk  of  an  e^-'j  in  a  little  slierrv;  or  a  luseu;!  with 
a  cupful  of  (onlinarv)  lieef  tea.  or  chicken  broth:  ail  are  suitable 
as  interludes  betwixt  meal-  the  more  serious  pi-tronmuic  per- 
formances. The  meal-  ,-liould  be  small,  so  as  nut  to  "  out  face  "  t  he 
appetite  (tu  us,,  a  provincialism),  and  just  enough  M-nt  up  a;  onec 
to  make  the  patient  think  a  very  little  nu>re  could  have  l.e.'M  eati'ii. 
Then  it  >houid  be  served  with  the  utmost  I'leanlitics-  and  .-eriii'  ilmis 
neatne.-s  and  daintiness,  so  ticces<arv  to  seeui'e  appetite.  I'ln'tiii-r, 
the  patient  is  never  to  be  a-ked  what  food  must  !..•  pr-'parc.-.!  a 
nur-e  wlm  can  do  that,  is  not  tit  for  the  pn-;ta>n.  iuii  jn-t  -ntue- 
thinir  nice  ma  !<•  and  sent  up  so  as  to  secure  that  agreeable  ., 
wh;eh  whets  tiii'  fastidious  appetite.  A  small  bird  on  tua-:,  a  :'• 
sandwiehe-;.  -mail,  thin,  and  m-at  in  appearance.  (  M:e  1-. .  .-\.  "i- 
one  !eii'_'th  of  sausaLT'1.  An  CU'L;'  with  -mne  l'a;r\  - 

blltt'-r.          A      -llia'%    Clip     i'f      ^(.nd      eiilVee     a!,d      Cl'eaill.      '"     i'll"e 

/ 

cocoa:    '':'  even    ti'a    \\';th    cream.      Ad    served    "ii   a    e.eaii    . 

pa :  r  of   hand-  clean  a-  We!;  as  wi,,inu'.   \v:d   i!i'!ii<-e  the  pa'  • 

when    lllliier    Oilier    eireUlll-tances     the    faee     ;-    a\e!"|i';! 

di-'^u-t  "n  :i-  features,  and    appetite    ha-   turned    n-    la   i\    ;•.          !--d. 
Such  a  meal  a-  di'senbcd  mi^ht   form  breakfast. 


TSII  M  AM  AL    OF    niKTKTICS. 

In  manv  cases  it  miirht  well  and  fittingly  be  preceded  bv  sonic 
milk  with  a  little  supir  and  a  small  (|iuuitity  of  nun.  or  brandv  (and 
a  suspicion  of  nutnici:')  in  it.  about  T  A.M.  Once  this  "ruin  and 
milk  "  was  a  far- fan  icd  and  sovereign  remedy  for  con  sum]  it  ion.  And 
there  is  no  dou  lit  t  hat  with  many  persons  such  "  hivak-fasi  "  is  <M»od. 
as  breaking  the  Ion:;  fast  of  the  in<jht.  after  which  the  ordinary 
lireaktast  can  lie  enjoyed:  where  \vithout  such  preparation  the 
stomach  would  feel  itself  unequal  to  a  heart v  meal.  Put  in  scien- 
tific phraseology  this  furnishes  to  the  stomach  the  matters  requisite 
to  the  formation  of  the  pistne  juice — known  as  '*  I'epto^ens. " 

At  11  A.M.  ill  ii:  lit  come  one  of  the  lit  t  le  interludes  just  spoken  of. 

For  lunch  a  cupful  of  white  soup,  or  vermicelli  soup,  with  a 
digestive  biscuit  and  a  small  sweetbread,  or  a  small  lish  as  a  sardine, 
or  anchovv  on  toast.  A  Lrlass  of  p-ood  red  wine  would  not  be  out, 
of  place.  Then  a  rest  on  the  couch  would  not  conn-  amiss.  At  4 
l'.  M.,  a  cupful  of  chicken  broth  with  plain  biscuit  broken  into  it.  or 
some  milk  with  Mellin's  food  mi^ht  be  taken.  I  (inner  at  li  P.M. 
mav  con.-ist  of  a  whiting  or  soim'  llat  lish.  followed  bv  a  chicken  or 
some  irauie,  a  little  bread  and  butter  pudding  and,  if  fancied,  a  little 
cream  cheese  or  a  nip  of  other  chee<e.  A  iz'lass  of  miod  port.  Bucel- 
la-.  or  Madeira,  or  Marsala  (according  to  the  purse)  mav  lie  taken. 
At  bedtime  some  treacle  posset  (milk  made  hot  with  treacle  and 
some  i:  i  n  <JT<  •  r )  mav  be  taken  on  u'cttinu'  into  bed;  and  the  rest  be 
put  in  a  jiiir  with  a  lid  (under  a  bi<r  tca-eosey)  for  the  small  hours 
of  the  iiiorninL:'.  Such  would  form  a  liberal  dietarv  during  the  hec- 
tic of  softening  tubercle:  and  as  soon  as  the  fever  abates,  some  cod- 
liver  oil  mav  be  added. 

The  fond  when  the  patient  is  confined  to  bed  should  never  be 
allowed  IK  remain  in  the  room  one  moment  more  than  can  be 
avoided.  Perhaps  grapes  are  the  onlv  exception  to  this,  lieiii";  cov- 
ered with  a  stout  impervious  skin,  the  sweet  tlesli  is  kept  from  taint. 
Onlv  just  as  much  fool  should  betaken  into  the  room  at  once  us 
the  patient  is  likelv  to  consume  and  no  more!  The  contrast  to 
this  i<  a  weak,  wasted  patient  with  a  wan.  worn  face,  and  a  hand 
almost  transparent,  ian'juidlv  looking  at  a  table  on  wh:eh  stands  a 
cup  half-fuil  of  milk  :  a  saucer  with  some  canned  apricots  in  it :  half 
an  apple  with  a  cut  surface  ^oinL:'  brown:  a  :_dass  with  some  half 
melted  ice  floatni'j  111  water  with  a  metal  spoon  in  it  helping  to 
the  ice;  half  a  L  lass  of  port,  which  has  been  there  ;m  hour  or 
more; — and  Irving  to  fix  the  resolution  as  to  which  of  the  ^I'mip  he 
try.  Xo  wonder  I  he  appetite  is  languid,  and  that  choice  is  dilli- 


The  physician  in; iv  l>e  dnMi'j;  aii  t  iiat  lit--  in  ii  •  -  p-  >\\  .  T  v.  •  ii  ::. 
en  II--.  nia\  arre-t  t  he  ni'_rht  sweats,  cnnt  ml  t  he  fi-\  «-r.  k'-<  ;•  '.!:•• 
r<"_Mi  ,ar.  ami  the  stoinaeh  in  ^m>d  ,-nnd  ;i  ;<  <}\ :    \>\\\   \\itlmut    th-1 
a    nurse    natiirallv   i_rift>-d    and    eaivi'uilv    t  ra  neii,    uh»    und'T-t.i: 
!'cedim_r  as  well  a.-  niir-,nu'.  the   results  are   un-a:  .-fa*-'.  .r\ .       I',;:    ;:;. 
physician    must    I'Vereise  a   general    supervision,  aii'i    have  a  \\.e-, ; 
praise  I'M i-  the   irood    nurse,  and  a  word    of   another  kind    I'm-   the    ;;  - 
eapaiile  "i1  run-less  nurse;    aihl  fur  thi-  he  ton  mu-t    i e><  ii  :^;-M.:I- 

tion. 

\\  hen  thn-e  times  of  'jastrie  irritahiiit v  eume     as  enine   th>'V  \\   . 

ami    >lo    111    ||lo>t    eases    of    ehl'ollle    |>htlli>;.-      -tllell    the    feeilinir    I'eenlln   - 

a  eanlinal  matter.  Sma.i  ijiiaiit  it  ies  ,<f  i;.jii;il  f !  a;  t'reijiietit  in- 
tervals are  essential.  After  some  stinlv  n|'  these  intereurreii!  attack- 
of  irasU'le  irritalii  ii!  \"  the  eoiielusion  arriveil  at  is  th;-.  the  Miore 
extreme  aibl  riui'i'l  the  ilietai'y  the  niniv  ipiieklv  'lie  stomai'li  re.-n\,'r- 
its  tone.  ( »n  a  vi TV  strict  ilietarv  this  ma\  lie  aehieve.l  in  from  i  w.-n:  v- 
I'mir  to  seveiitv  hours:  whereas  on  a  niuileratelv  raivfui  [•••Lrinien 
onlv  it  mav  l.ie  a  week  or  ten  ilavs  liefore  the  gastric  il:>turliaiiee  . 
i  >\  ereoilie. 

A  .-mall  nutritive  enema  o!'  treaele  ami  warm  water  iha.f  ai,«i 
haif)  or  a  s\'rup  of  miik-sii'j'ai1  or  ^Tape-suu'ar  ma\  he  ^u^n  thrive 
ilailv,  to  help  to  maintain  the  general  nutrition.  ( )r  the  Unly  mav 
lie  ruhlied  with  oil  -  -;.>  a  make-iiift. 

\\'ith    moileni    kiiowieil^-e    of   digestion    and    hodv-reijuiremen! -. 
\\ith  a  more  perfect  irnp  of  the  essential  wants  of  the  pht!n.-ica!      "f 
the  importance  of  arrestini;'  all   out^oinu's.  a-  well  as  thai   of   the  in- 
troduction  of   fond   at    once   dip'stihle  and    nutritive,  ;he    pi-n-pe  •: 
of  the  phthisical  arc  much  Kn^liicr  than  lhe\    were  ai  the  he^inni! 
of   the   [ircsent   ceiiturv.      A  suspicion    thai    then-  i.-  a  diiVerem-e 

IWlXt    lllel'eiv    'Jet  1  111-'    food     (loWll    lllin     tile     Stolliai'Il    and     i!-    >\    L't'jf    ""<- 

is  ah  road  :  and  that  a  tahlespoonful  of   milk  and   Men  in'-  f ,  u  :.'    ii 

is  digested,  is  reallv  liettci'  I'nr  tin-  patient  than  a  !  ><•<  •!'--!  <  M  1\  w  iJ.':  MI 
simplv  passes  thrnu-'h  the  aliinentarv  canal.  T<>  -uppra  B  •he 
much-tried  nru'uiu-in  il1;,t  whi'-h  it  reallv  ivijitiiv- 

etliciellt     help     In    it.         |-'a!    for     pl'e\  etl  I  "lot  i  ;      fat     l'o|'    cure          I'.'.;' 

tin  re    is   pistric  iri'italiilit v  mi  foot,  ii   is  a  ca-e  of    m    is    ;.'•'';    ' 

oH'crcd   to  t  he  consuinpt  i\  e      and   which  I  he  ;n\  ,-!•;' 

tn   swallow      have    m>  advantaLT'1  n\er    ihe    IIMU.I';  .   .  o          ;.   :,  -» 

iiiii'-h  ha-  lieeii  -aid   in   tin-  t  real  i~<\ 


All  aioiit:  the  line,  whether  during  the  periods  of  comparative 
health,  or  times  of  acute  peril,  with  patients  with  a  phthisical  ten- 
iieiicv.  thetz'reat  cardinal  matter  is  the  nutrition  of  the  organism. 
To  Imild  up  healthv  tissue  is  onr  aim;  and  for  that,  fat  is  essential. 
And  nsuallv.  fat  is  loathed  and  avoided.  Imperfect  nutrition  is 
what  we  have  to  contend  with,  and  the  side  from  which  danger 
is  ever  threatening,  more  or  less  seriously.  Cod-liver  oil.  oil  emul- 
sions, preparations  like  Cremor  Hordeatus,  and  Oleobvne.  all 
strengthen  our  hands,  as  regards  the  [icrmaneut  treatment  of  the 
plithisical.  In  t  hose  periods  of  gastric  disturbance  to  which  such 
patients  are  liable,  prepared  foods  are  invaluable.  "  The  subjects  of 
pulmonary  phthisis  resemble  in  one  respect,  hand-fed  infants.  Like 
them,  thev  are  liable  to  repeated  attacks  of  Castro-intestinal  catarrh, 
which  trives  rise  to  indigestion  and  flatulence.  These  attacks,  bv 
the  inlluence  they  exercise  upon  general  nutrition,  may  produce 
verv  serious  conscipiences. "  So  savs  Dr.  Eustace  Smith,  in  the 
art  icie  on  Chronic  Pulmonary  Phthisis,  in  his  classical  Treatise  on 
the  Diseases  of  Children:  and  his  experience  at  the  Chest  Hospital, 
Victoria  Park,  agrees  with  mv  own.  that  intercurrent  attacks  of 
disturbance  of  the  alimentary  canal,  and  with  them,  failure  of  the 
nutrition,  are  amonu;  the  most  serious  complications  we  have  to  en- 
ei'iintcr  in  the  treatment  of  Consumption.  And  this  is  even  more, 
true  of  children  and  verv  vomit:  adults  than  of  older  phthisical 
patients;  but  even  with  senile  phthisis,  the  dilVicnitv  of  maintaining 
the  nutrition  is.  the  threat  stumbling-block  in  their  treatment. 


CTLVPTKT1    XXTI. 

FOOD    IX    CHRONIC    IIKAKT    AND    l.l'NC    DISKASK. 

SDMI:  critical  reader  may  fed  -urprise,  or  be  inclined  in  s.-niT  at 
tin-  distinction  made  herein.  1<  not  I'hth;-;-  a  lunu'-disca-c !'  }\<- 
may  ask.  Certainly  pu  ini'  'iiarv  coniplicat  ions  are  \  crv  common  with 
phthisis,  aim  1'ivijUriitlv  fni'in  tin1  main  trouble  ami  tin-  ijau-c  of 
ili-ath:  but  all  the  same,  hut  admitting  this.  |iulniniiarv  phthl.-l.-  ha- 
no  )-i-'ht  to  he  classed  as  lunir-diseasc— in  tin-  proper  sense  at  ,iA.-t. 
That  \vuiilil  he  niislcailiiiL;'.  I'lilimmarv  Phthisis  is  imt  a  pivtuarv 
lunir  ilisca-'".  as  chroni  •  Mroncliitis  and  l''.in j'li\-rina  certainly  an*. 
1'ldii'it  ic  disease  mar  certainly  exist  in  a  jM-rsnn  \\itii  phihi-ica.  ten- 
dencies, and  then  a  condition  ivscinlilhiLr  />/tt/ii*ix  jii'/iinniirii.x,  uiih 
the  same  indications  I'^r  treatment,  mav  lie  sei  \\\<.  l!ut  uhat  ;< 
meant  hv  the  a  hove  heading  arc  cardia'-  aircctuins  and  inorliid  slate 
ot  tin-  IIUILT.  u'hi'-h  interfere  with  the  t!o\v  of  hlnod  t  liroK'j-ii  th«- 
|udinonic  cin-uiat  ion ;  and  the  obstruction,  working  liackwards, 
proiluces  conire.itioii  of  the  portal  circulation,  and  the  viscera  con- 
nected therewith. 

(Acute  picurisv  or  pneumonia  requires  t  he  dietet  ic  management 
laid  down  in  t  he  ( 'ha pter  mi  "  I-'m »\  in  Acute  Disease:"  while  a  con- 
dition of  pleuritic  ell'usion.  or  eiiipyt'ina.  would  rather  he  lu-tter  met 
bv  the  line-  laid  liown  in  the  pre.-cnt  chap!'T.) 

\\  ha;  i-  deal!  \\';th  here  is  a  condition  which  mav  broad! v  be  sii«i 
to  be  the  oppositeof  (or  antau'onistie  to)  phth:s:<.  Mot  1 1  cardiac  (valvu- 
lar) iliscase  and  chronic  bronchitis  and  emphv-cma  are  ir.compat  h'c 
with  tuliercle.  Tu I ici'i'ii lar  disease  of  the  [un^  mav.  and  tiocs  -o"!(. 
t  inie<  co-rxi>t  w;lh  val  villa r  di-ca-e  of  t  he  heart .  or  w;t  h  emph\  -ema  : 
but  so  verv  rarelv  that  tin-  very  fa>"  ha-  been  called  in  ijiie-'  on. 

M' ith  IJokiian.-ki  and  the  late  Dr.  1'ca- k  held  that  \a<cif.ari  n-o  -c- 

ineii!  of  the  !un-'.  which  follows  upon  mi-chief  at  the  mitral  \a  \e. 
wa-  iiieom  pat  ilile  with  tubcrcic.  \\'hilc  i;  ha-  bc.-u  pro;...-c.l  'o  -ri 
ii!'  art  ilieiallv  a  eoiiii.tion  of  eiiijihy-cma  a.-  a  pi'oph\'!ac! .  •  n:ea.-:.  :<• 
in  ihreateiied  piilmouarv  phllii-is  onlv  nobo.i\  k;  e\\  ho\\  •  \\-a-*  ;o 

be   done. 


1^4  MANUAL    OF    niKTKTK'S. 

offered  to  tlu1  How  of  h](K)(l  through  the  pulmonic  circulation,  and 

the  etl'ect  of  this  upon  tin1  blood-current  ami  blood-vessels  behind 
the  obstruct  ion.  A  certain  damming  of  tin- current,  is  the  result, 
and  with  that,  congestion  of  the  liver  (impeding  and  impairing  its 
functional  activity).  and  'behind  that  apiin  congestion  of  the  portal 
vein  and  its  venules.  The  elTect  of  this  venous  fulness  is  felt  ill  the 
stomach  and  intestines:  and  feeble  digestion  and,  si  uppish  bowels 
are  the  consequence.  The  condition  of  the  mucous  membrane  is 
favourable  to  tlu1  production  of  pis,  pviiiLT  tlatulence.  Flatulence 
is  one  of  tlu1  e,Teatest  troubles  of  persons  \vitha  crippled  heart  or 
chronic  limp-disease.  The  pressure  of  the  elastic  ^as  prevents  the 
descent  of  the  diaphragm  and  so  further  embarrasses  the  breathing. 
So  pronounced  mav  t  he  ditlicult  v  of  breathing,  so  set  up.  become, 
that  the  term  "asthma"  is  applied  to  it  by  t  he  sult'erer.  The  dis- 
enpiu'cmeni  of  pis  in  valvular  disease  of  the  heart  is  sometimes  so 
pvat  that  it.  pours  np  the  (esophagus  producing  loud  noises,  and 
continuing  for  some  time.  The  term  "  heart- wind  "3  is  applied  to 
this  explosion  of  noisv  eructations. 

Another  eonset|ueiice  of  this  venous  .fulness  is  that  the  patient 
.feels  "  full"  even  when  the  stomach  does  not  contain  food.  It  is 
neeessarv  to  «_;-o  over  this  pathological  ground  as  a  preliminary  1"  the 
discussion  of  the  food  appropriate1  thereto  for  the  instruction  of  the 
non-medical  reader,  in  order  that  he  may  the  better  uva-p  what  is 
here  said. 

From  the  venous  congestion  of  the  whole  abdominal  viscera 
impairment  of  function  follows.  The  stomach  is  enfeebled,  and 
pr;marv  digestion  is  lowered,  while  the  working  of  the  liver  is  em- 
barra.--ed.  and  much  of  the  proteid  matter  which  reaches  it  is  never 
carried  forward  as  the  albumen  of  the  lii/nur  X<IH<IIH  ntx  for  the 
nut  rit  ioi;  of  the  tissues,  but  proceeds  on  a  downward  career  toward 
uric  a'-id  and  urea.  The  condition  of  the  urine,  more  or  less  laden 
with  Inhale.-,  tells  of  the  faultv  assimilation.  It  is  impossible  to 
feed  the.-e  persons  up  bv  ^ivin^  liiein  lai'^'e  (jiiaiitities  of  animal 
food:  this  simplv  add,>  to  the  li\'er  embarrassment.  The  amiable 
intention  mei-eiv  link-  a  condition  of  hlhiasis  to  the  pi'e-cxi~t  m^ 
;  rouble.  It  is  well  to  bear  tin-  in  mind  in  feed  MIL:'  persons  with 
chronic  disease  of  the  liin-js  and  heart.  The  more  severely  ill  the 
|e.-s  the  jissi  m  i  hit  i  \  e  eapaeitv,  and  the  solul'le  ca  rbo-hvi  1  rat  es.  all  but 
"•'.]'•'.'  of  tin  ve  act,  form  almost  the  only  food  that. 

i! '  a  :  isi  H'bed. 

\\hcii    lairlv  well    persons,  with   old-standing  valvular  disease  of 


tli-1    lii'art.    •>}'   with   chronic   bronchitis  ami    emphysema,    or 
einphvsemu  alone,    can   share    the    family    meal,    pc'-hai'-    tL'->. 
out    liiat  certain  food-    di-a",Tee  with  thrill  and  e-.-hew  pork  a:  d  '•  • 
(and    some   i-vi'ii    pi^eon-l.    he  MILT   scn.-ible   ari<l    rational    indi\  idiul- : 
but    bevond    this   it    is   nut    necessarv    for  them    to   --0.      '1'hev  pivfe- 
hi;_rhlv  .-easoiieil  ill-he-,  a-    the   carminative   pepper  ,-  ^mid    for   th'-.r 
flat  iilence.       Mustard    ton   thev    patroni.-e.  and    thev  i  ;ke  a  •_"  >"d    iiea 

of     LT.HLVr     Wltll     tliell'     llleinll.         ('llUtliee     theV     fill'!      -Ill'--     them;      ;i!l<i 

tiiev  aiwavs    weleomt1    niuiliLratawnv  soup,  aii'l    sn:tT    u;th   an    air   of 
sat  i-i'a<'t  ion    when   a   curry  appeal's  on    the   seenc.      l-'i-h   nn   nrnti/i 

SUMS     them,    e.-peeiallv     \\llell     We'll     .<ea.~Ol|ei  1 .         (  'a  !  1  i  1  tl  i  >  Wi  •  V    ali'l      Ve^fe- 

talrle   marrow  in/  //ri/fi/i  ran  lie  treateil    in    the  same  manner  and    !>e 
on    intimate    term-    with    the    pepper   eastnr.      A!i    smips   and    ma«le 

liislle-     to    which     Seasoning    eail     lie    a'1'ieil     are     ill     Vo-j-ue     Ultll     them, 

and  all  kinds  and  varieties  can  lie  made  l'»r  tln-ui.  1'utato^-  can 
lie  >ervril  up  \\ith  a  liu'ht  boiled  e'_;~'_r.  and  peppered  to  taste.  l-'i'e-li 
meat  minectl.  and  seasoned  with  a  wail  of  ma-hed  potatoes.  woii,il 
form  a  lit:  in  ur  di>h.  .M  inced  col  lops  would  not  conic  ami»:  while  a 
Sco'climan  wouii'l  doulitlcss  uilvoeute  ;i  hau^'is.  or  a  >heep's-liead  pie 
—  wliii-li  can  hardlv  he  over  peppered.  Kntreesof  ail  kinds  could 
he  prepared  to  meet  their  requirements.  An  Irish  stew,  or  pepper 
pot.  or  hotch-potch,  would  not  he  rejected  hy  such  persons  if  \\vll- 
sea-oned.  I'rohahl  v  t  he\-  will  prefer  pepper  and  I  (Utter  with  a  'naked 
apple  rather  than  .-nu'ar.  I'l'^'s  feet  or  tripe  could  lie  ppepareii  to 
their  mind.  A  fat  little  pi  IT'S  cheek  ciil  in  pieces  and,  served  up  hot 
with  a  saner  piquant  would  form  an  excellent  d;-h.  esp'-eiaih  where 
there  is  anv  Li'outv  eomplicat  ion  -a  vei-v  common  oecuri'ence.  Thev 
would  prnl. alii  v  he  more  likelv  to  pav  t  heir  at  tent  inn  to  '_nii'_rer  snap-, 
eoriani'ler  cookies,  ilian  to  cranberry  tart-,  or  huckleberry  cake,  or 
jumbles.  Mullinsand  "  mot  lier's  cruller- "  thev  wmild  be  like-U  '<> 
pa--  iintouchd!.  but  their  eves  mi'j'lit  rove  to  a  u'inu'er  brca-i  loaf. 
(  'hocoiate  cake  and  marble  cake  would  not  excite  t  heir  CM !  in; -  a  -in. 


of     Ll'iti'Jef    or     llUtlne-j-.     ail'!     cloves     could      be     Ut.llseii     ul'I' 

oppvrt  unit  v  occurred.      Cinnamon    i-   -"""d    m    a    r:<- 
mulled  claret  i.-  a  comfortable  drnk  in  cold  weather.      Sn 
admit-   of   a    •_•<  >od    deal    of    pepper,  and,    inn  ili'jrataun  v  \CL-I 
e-(ioi|    in;-    ilatuleiit     jierson-.       Mushrnnni-    can    !"•    eoo^i    ; 
wav-  and   readilv  lend   I  hem-elves  to  i  he  cook'-  ;•"'  a- 
!•':-;:    pii'idin-'-   ami    pa-le   could    le   speeial'v  -•:•!-•  *ll'    .. 
ma1.-  nnai-c  would    nroliablv  at  their  hand-    be   (!'•• 


IM'I  MANUAL    OK    DIKTKTIOS. 

tional  pepper.  Totted  fish  should  be  specially  prepared,  for  added 
pepper  cannot  ai\va\s  take  the  place  of  seasoning  put  in  at  the 
proper  time,  as  in  meat  puddings  and  pies  for  instance.  Their 
whitebait  mu.-t  lie  devilled,  and  their  prawns  lie  served  as  a  curry. 
Not  that  their  stomachs  arc-  to  he  made  a  perpetual  spice-mart,  hut 
their  wants  as  well  as  their  palates  must  he  consulted. 

The  three  things  to  he  aimed  at  are.  readiness  of  digestion,  a 
proper  proportion  of  carminatives,  and  ;i  suitahk1  hulk, — the  latter 
heiii::'  a  matter  entirely  under  the  control  of  the  individual.  Small 
meals  at  no  long  interval  should  lie  the  practice;  and  a  light  supper 
is  essential  to  a  good  night.  A  substantial  supper  is  very  liahle  to 
he  followed  hy  an  attack  of  dilliculty  of  breathing  in  the  night,  and 
is  a  mattei-  of  certainty  with  many  persons  suffering  from  disease  of 
the  heart. 

As  to  the  amount  of  alcohol  such  persons  should  take,  t  he  answer 
is  a  dillicult  one.  Kin*;  Chambers  says  of  alcohol  in  disease  of  the 
heart  — "  Let  the  alcoholic  drink  be  limited  to  that  quantity  which 
increases  the  appetite.  In  a  great  many  instances  this  quantity  may 
be  verv  shortly  written  down — 0."  No  doubt  this  is  ipntc  true  of 
some  persons,  especially  those  persons  to  whom  alcohol  is  a  poison, 
no  matter  what  is  the  matter  with  them,  whether  it  is  their  heart 
or  their  liver.  Some  generous  wine  \\ill  very  commonly  be  found 
to  aurive  well  with  persons  with  old-standing  heart  or  lun<_r  mischief, 
and  will  help  them  at  meals.  In  attacks  of  dyspno'a  some  alcohol 
as  a  stimulant  is  of  incalculable  value.  As  cordials  alcoholic  com- 
pounds are  excellent.  Ali'ohtil  (/*'  Men/he  has  done  me  excellent 
service. 

When  the  condition  is  marked  and  the  patient  gravely  ill,  then 
a  dietary  of  liquid  food  is  necessitated  and  meat  infusions,  predi- 
gested  starch,  and  milk,  become  imperatively  called  for.  King 
Chambers  also  points  out. that  with  some  persons  who  have  dilated 
hearts  a  "  sloppy  diet  "  does  not  always  agree.  ( 'ertainly  t  here  are 
persons  who  can  not  get  on  with  liquid  food,  but  they  are  the  ex- 
ception and  not  the  rule.  The  observation  is  the  outcome  of  the 
writer's  exten-i\  e  knowledge  on  the  subject  of  dietet  ics,  which  makes 
him  more  observant  of  the  except, on  than  the  rule. 

When  a  verv  advanced  condition  is  reached  then  the  admixture1 
of  alcohol  with  the  food  becomes  imperative.  Milk  with  some 
brand  v:  a  little  beef -tea,  or  "  invalid's  soup,''  also  with  some  brandy, 
not  Ujru'et  t  'ing  to  add  some  soluble  carbo-hydrates.  One  caution 
airain  must  be  observed,  and  that  is  not  to  push  the  alcohol  when 


svmptoms  of  acute  ^astrir  disturbance  appear.  Sometimes  :;  '. 
yerv  d  ill  ic  ult,  choice  In  make  in  deciding  what  is  M'-t  for  :  In1  pa: .1 •:  = 
<;•<!( it i.  when  to  risk  the  withdrawal  of  alcohol,  and  uhcii  to  remem- 
ber tin-  irritable  condition  of  tin-  stoinai'h.  The  introduction  of 
solid  ilt'  carl  HI-  hvd  rates  into  common  use  is  he!  piiiir  to  sett  le  t  he  ipie-- 
tion.  \\'hiie  it  was  a  case  of  choice  betwixt  food  that  required 
diLfe'tion.  and  the  alcohol  which  passed  readilv  into  the  Mood  and 
was  luinit  in  the  organism,  then  the  alcohol  had  the  preference, 
lint  now,  when  so  inanv  preparations  of  soluble  carbo-hvdrates  ;uv 
at  hand,  it  liecomes  possible  to  limit  the  amount  of  a'.'-ohol  to  the 
reijuireinents  of  the  svstem  as  to  stimulant,  other  readiiv  combusti- 
ble hvdro-earbonaeeous;  mailer  beinir  sulist  ituted  for  it  as  a  food. 

And  this  is  a  matter  of  cardinal  importance  when  conditions 
threateninir  exhaustion  are  present.  As  for  instance,  when  some 
fre.-h  acute  bronchitis  is  added  to  old-standing  bronchitis  and  em- 
jihvsema.  or  is  super-imposed  upon  a  condition  of  advanced  mitral 
di.-ea.-e  with  permaiie:it  congestion  of  the  pulmonic  circulatimi.  I: 
has  seemed  to  me  that  when  the  capillaries  of  the  lun^  (whii-h  an- 
normally  of  comparatively  lar^e  calilnv)  liave  for  IOM--  hcen  ilisteinU-.i 
liv  a  Mock,  at  the  mitral  ostium.  tliev  i-eadiiv  ^:ve  \\av.  of  vieid 
uhen  some  ne\v  force  is  in  action.  IIe[tatisat;on  of  the  iun^s  is  very 
apt  to  spread  and  extend  where  there  is  old-standing:  mitral  di-ea-e. 
and  then  a  condition  of  acute  danger  is  devcli.ped.  reijuiriii'j  t  h" 
most  watchful  care,  and  calling  not  onlv  for  appi'npriate  medicinal 
measures  Mit  for  skilful  measure-  of  feed  HILT.  Tiie  svstem  and  with 
the  general  condition  the  digestive  organs  are  in  no  condition  to 
meet  anv  demand  upon  them  for  assimilative  purposes.  Sma.i 
(|iiantities  of  readily  assimilaMe  foml  mu-t  lie  supplied  to  -ii['port 
the  sorely  taxed  organism.  As  to  the  assimilation  of  fat.  it  i-  very 
douhtful  how  far  it  is  possible  at  all  in  these  conditions.  A  :/,an'V 
at  the  urine,  hi^h-colourcd  and  laden  with  lithates,  tells  that  the 
liver  is  in  no  condition  to  deal  with  lanre  i|uantities  of  albuminoids, 
even  if  the  stomaeh  could  digest  them.  Then  the  paia'c  has  to  !H- 
considered:  fat  is  loathed,  and  predi^estcd  album;noiil-  are  no!  en- 
joyed. How  then,  and  upon  what  is  the  patient  to  feed;'  The 
needful  p'l'a  pe-.-iiLI'a  I1  must  be  Mipplied  to  it.  else  the  or-'aiu-m  Will 
burnout  like  a  lire  imperfectlv  supplied  with  fuel.  There  arc  no 
doubt  medical  men  to  be  found,  who  regard  with  iuditl'erence  the 
matter  of  food  and  its  di^estibilitv.  and  \\'ho  order  "-'.ops  '  w;'h 
bin  very  little  discrimination  as  to  whai  the-e  shail  con-'-;  of;  b;;1 
the-'1  are,  as  a  rule,  men  \vho  have  n..i:  dee.plv  I'on.-idered  the  . 


MANUAL   OF    DIETETICS. 

ject  <>f  dip-si  i<m  ami  its  processes.  The  advanced  physiological 
knowledge  of  the  present  dav  is  deinonst  rating  what  it  is  the  body 
requires  when  in  straits,  and  ho\v  to  supply  its  wants  in  a  form  call- 
in  LT  for  the  in  in  in  nun  of  the  digest  ive  act.  They  remind  me  of  t  hose 
persons  who  could  not  see  the  advantages  of  ( Jeopjv  Stephenson's 
invention  of  the  locomotive:  and  onlv  held  a  railroad  to  he  inimical 
to  the  coaching  interest  and  the  breeding  of  horses.  These  persons 
will  inevitably  become  rarer  and  rarer,  as  man  is  mortal  any  "  rarity 
is  the  precursor  of  extinction  "  as  we  know-  to  make  way  for  yonnp-r 
men  mure  intimate  with  the  i'acts  of  physiology. 


OTLYPTK11    XXIII. 

FOOD  IN   r,i;i<;iiTs  OISKASK. 

ON  CT:  more  a  certain  amount  of  pathological  consideration  mti-t 
precede  tlie  sultjcct  proper,  this  bein^  e.-peciallv  uecessarv  I'm'  non- 
nu'ilicul  readers. 

'"  Hriirht'ri  disease"  is  a  disease  of  tin-  kidncvs.  it  i-  comnionlv 
taught:  and  its  evidence  is  to  tie  found  in  an  aibuminou-:  urine. 
This  is  about  as  accurate  as  to  sav  thai  the  llierian  peninsula  ', 
K  u  rope,  and  t  he  K tiro  t  lie  chief  river  of  Kurope.  ••  I',  right's  dis>-a-e  " 
of  the  tuhular  nephritis,  or  lanr1'  white  kidnev  tvpe.  and  amvioM 
<>r  lardaecous  kidnev  varietv.  niav  fairlv  lie  spoken  <>\  a-  "  k;di;e\ 
disea.-es.  liut  of  the  granular,  eirrlmtic.  cotiti'aeted.  red.  LTo;it\' 
kidney — l>y  far  the  most  common  form  of  r>riu'hf-  disease,  it  is  im- 
possible to  spi'ak  as  a  mere  localised  "kidnev"  disease.  It  H  a 
matter  of  widespread  change,  in  \vhieh  the  ein-ulaturv  svstem  ha-  a 
marked  share,  and  in  which  the  kidnevs  arc  also  involved.  Ttie 
eondit  ion.  is  one  of  waste-laden  blood :  where  the  lilood  i<  surcharged 
with  nit  1'o^eniscil  waste.  There  i-  impei't'eet  action  of  the  iiver, 
wliich  fails  to  convert  the  alluiminous  matters  into  scrum  albumen 
(for  t  he  nut  rition  of  the  tissues)  and  urea  ( the  so!  tittle  form  of  rr.tro- 
p-nised  waste).  Instead  of  the  latter  there  i-  a.  distinct  tendency  '<> 
form  uric  acid,  the  primitive  form  of  nitrop-nir-cd  waste.  Mam- 
malian livers  normallv  form  soluble  urea:  but  when  the 
developes  a  tendency,  or  rather  and  more  correctly,  rc\  erts  or  !'a!.- 
hack  to  uric  acid  formation,  then  the  kidneys  suH'er  secondar;.} . 
I'rofessur  (Jc'o.  .lolinson.  l-'.K.S..  put  it  happily  in  his  well-kin 

Wurk     on     l)i-''a.-e~    of    the    Kldliev.-     -"  I'l'lliti    '!>  ',''//•/'"'  '"/' 

ifin  ii'-i'   nf    /n, /(/-''I, ilfi/l  I/I'd  ,  llmi  il''ti"H     nf  / ./'"'  I  u,"  v   nl'    t',/ n't  it   <!•.• 

tlii'inii/li   /In-   /,•  ill iii-i/*. "      As   allmminoid    matters  a-    proteii 
enter   the  blnoil.  this   faultv  dip-stion   doe-  not  lie  in  the  a;:men 
canal.       Soluble    peptones    alone    enter    the    portal     ve;n;     ati'i 
"  fault  v  digest  ion."  we  now  k  now.  lies  with  the  liver.       I  he 
point    of    llri-'ht's  disease,  then,  may  lie  said  to  bi- 
llow far  natiiraiK   inetlicieiit   kidneys,  or  kidney- 
a-    -carlet     fever,    liv    their    inadei|iiaey    to    -.••    ;-.d   .•; 


I'.IO  .MANTAI,    OK    DIKTKTK'S. 

Hrates.  help  to  the  condition  of  the  blood.  ;uul  to  accnmnlation 
therein  df  excrementitiouH  mutter,  is  u  subject  on  \vlnch  opinions 
inuv  dill'er.  1  Io\v  fur  tlic  first  departure  from  health  is  mental  worry 
or  overs! rain —  \vliicli  notoriously  all'eets  t  he  liver  ami  the  assimilat i  vo 
organs  injuriously — \ve  do  not  yet  know.  ClilTonl  Allhutt  regards 
line-lit  's  disease  as  having  t're(|uently  sueh  a  mental  origin. 

\\  hen  these  mal-product  s  are  formed,  and  exist  in  excess  in  the 
blood,  two  things  may  happen: — 

1.  The  kidneys  may  become  injured  by  the  output  of  these 
lithutes:  or 

'.'.  The  excremeniit ions  matters  are  retained  in  the  blood,  ^ivin^ 
rise  to  lithiusis, — or  u'out  in  its  widest  sense. 

Frequently  and  not  uncommonlv  more  or  less  of  "both  is  found. 
Certainly,  polity  persons  have  ^outy  kidnevs.  Hut  a  well-marked 
condition  of  Hri^ht's  disease  niuv  exist  which  all  phvsieiuus  would 
class  as  Hri^ht's  disease,  and  not  as  ^out.  In  such  cases  there  is 
p-nerallv  a  certain  pallor,  (sueh  is  the  Hriirht's  diseuse  seen  so  much 
in  (iermany)  while  a  polity  aspect  is  more  common  in  Fnu'land. 

In  this  widespread  change  the  urine  mav  or  may  not  lie  albu- 
minous: or  onlv  albuminous  at  times;  or  it  mav  not  be  albuminous 
(.Mahomed).  Manv  hold  that  in  this  chronic  ^ranular  condition  of 
the  kidney  albuminuria  is  not  essential  to  the  diagnosis,  and  that, 
when  certain  other  changes  are  notable,  the  absence  of  ;dbumen 
from  the  urine  carries  with  it  no  comfort.  Hvthe  overwhelming 
importance  attached  to  one  symptom  and  the  neglect  of  the  other 
scnic'a.  a  uTeat  deal  of  error,  confusion,  and  misapprehension. — ave, 
aii'i  it  is  to  be  feu  red  much  unnecessary  mentul  discomfort. — huve 
been  occasioned.  Surely  there  is  enough  unhujipiness  in  the  world 
without  adding  to  its  muss  unnecessarily.  Albuminuria,  too,  has 
other  ussoeiut ions  than  Hri^lit's  disease. 

Such  then  is  I Jriu'ht's  disease  as  ordinarily  encountered. 

I  am  old  enoiiLi'h  to  remember  when  the  teaching  was  -meet  the 
drain  of  albumen  hv  liberal  ipiantities  of  albuminoid  food.  This, 
it  is  needless  to  say.  was  an  outcome  of  imperfect  ae(|iiaintance  with 
the  nature  of  the  maladv.  and  a  superticiul  conclusion.  It  stood  on 
the  ,-aine  chronological  platform  as  the  advocacy  of  the  llesh  of  car- 
nivorous  animals  for  diabetes.  It  was  at  that  time  thought  that  the 
threat  matter  wus  to  keep  the  albumen  from  pus.-in^-  out.  of  the  bodv: 
and,  when  this  could  be  successfully  done,  to  introduce  plenteous 
supplies  of  it. 

.\o\v  a  Lrivat  change  has  come  over  our  views.      The  teachimjf  of 


(ie-o.  Johnson  has  had  a  profound  mtluenee  upon  tin-  :>:•••-> 
t'on.  and    tin1  in"-;    recent   work-  <>n  the  subje,-t    ho..;    n;"- 

tln-    vii-u"   nt'   nit  roirenised    wa-to    in    ;he    hi i    ]. »•'.}, ^   i'ii'-.- 

I!ri;.:ht's  ilist-asi-.       1'nuit    did    -• 1    w<>rk   am!    so  .i'i.!   i.;,r-»d. 

t  lie  voHm_:er  men  of  t  his  LTenerat  ion  an-  a'i  fam;l  lar  \vi;  h  :  •..•  • 
of  rhniiiii'  l>ri:/lit's  disease  to  the  albuminoid    cii-iii'-nt  -  -if  oui 


manv  eases  a  mental  factor  plavs  a  prominent   pan   m  ;  he -tar;  :n_r 
of  the  morbid  condition.       In  other  eases  the  -tar  .:;•_;•  P. .in;   ;-  ,-\  -.--- 
sive  indulgence  in  animal  food.  /./..  beyond  the  bo  iv-ii-.-.-d-.      \\'i;.'!i 

t  here  e\  ists  evidence   of    renal    lliadeijliaeV,    then    ;I    bei-olue-    !iee.-<-arV 

to  limit  the  work  thrown  upon  the  kidnevs.  \\  ha:  amount  of  evi- 
dence would  be  accepted  as  conclusive,  and  wha!  a-  HUT'-lv  - 
picious.  but  not  proven,  is  a  matter  upon  whi'-h  opinion-  mav.  a:,d 
nio-t  probably  would  ditVer:  and  I  am  hv  no  mean-  i!:c'.ine(l  to  :-P-p 
out  of  m  v  \vav  here  to  attempt  to  settle  the  point.  If  anv  doubt 
I'.xists.  it  will  be  well  to  err  on  the  side  of  caution. 

In    the  lirst    plaee.  then,  it  i-  well  to  iv.-tricl   the  amount  of    lean 
meat,    con-umcd.      The    lle-h    of    the    larger   animal-,  bee!',   mutton, 
pork,  no  matter  whether  a-  adults  or  juveniles,  must    he   taken    in 
st  ri'-t  mode  rat  ion :  and  with  due  regard  to  i  he  needs  of  the  hod  v  and 
its  tissues,  and   not  to  the  cravings  of   the  palate    -nor  \et   the  -tom- 
aeh.  whieh    leans  to  meat.      The   joint    is    best  avoided,  miles-    it    be 
the  fat  of  it.       Made  dishes  arc  often  permissible,  and  entrees  .-an  lie 
made  which  pratit'v  the  palate   without  taxing  the  liver.       Liver  and 
bacon,  for  instance,  is  a  suitable  di-h.  though  some  would    lake  ex- 
ception to  the  albuminoid  element  in  the  liver.      Stews,  with  plen:\ 
of   vegetable    matter  and    fat.  are    preferable    to   joints.       I;    . 
that,  legumes,  which  are  rich  in  nitropMi,  should  ii"t   be  a  lar^v  co;i- 
stituetit    of   the  stews.       Hashes   with    plentv  of    \e_uvtable  mailer,  a- 
turmps,  carrots,  eelerv,  onions,   leeks,  and  \\ith  a  limited  amount  of 
lean  meat,  are  irood  and  palatable.      A  vegetable  entree  -hi«tild  f^rm 
one  course  at  dinner.      1'rovided  t  tie  d  i'je.-t  ion  beLT'ii'd.  pas;r\ 
contra-indicated,      ('akes.  crackers,  biscuits,  swei-t  corn,  arc  all 
missible.      Salads  should  form  a  distinct  element   in  lhed:e;ar\:   a 
fruit,  raw  or  cooked,  mav  be  taken  bv  ih"-c  with  whom   .' 

( 'ertaiidv  there  are  SOJHC  cases   of    lir^h:'-    i:sea-e  \ 
proiiouneed  aiia-mia.  to    which    the  abo\e   dietary  :s  HO;    a:-i  •  •-. 

ami  where  a  more  distinct  animal  ilc-h  dieiar\  i-  :",. ;  ,>•;!•<  • ;.  ?.»:.;•;  :•< 
the  bulk  of  per.-otis  with  I  Jri^'lit's  disease,  where  I  he  nn:  r.:  on  :  •  ;. 
t  hese  remarks  apply. 


l',ll>  MANUAL    OF    IHKTKT1CS. 

Fish  in  all  forms.  ;ill  kinds  and  however  cooked,  are  admissible. 
Hut  here  again  we  must  remember  that  fish  is  albuminous,  and  that 
unlimited  lish  even  may  be  harmful.  Shell  tish  and  molluscs  form 
an  agreeable  change. 

Soups  of  all  kinds  mav  be  taken,  a  preference  IK-HILT  Driven  to 
those  where  the  amount  of  "stock  "  is  small.  Those  prepared  with 
cream,  and  those  thickened  with  farinaceous  matters,  are  to  be  pre- 
ferred. Soups  can  be  made  thick  with  vegetable  matters,  and  such 
soups  are  good. 

Persons  with  liright's  disease  will  do  well  to  learn  to  eat  fat. 
Thev  should  [nit  cream  (as  understood  in  Kngland)  in  their  tea  and 
cotTee.  eat  plentv  of  butter  on  their  bread,  should  be  given  to  bis- 
cuits and  butter  at  lunch  and  dinner:  should  have  real  melted 
butter  to  their  lish:  and  should  not  be  niggardly  with  the  oil  in 
their  salads.  A  basin  of  porridge,  either  of  oatmeal  or  hominy,  fol- 
lowed by  a  rasher  of  fat  bacon,  or  tish  with  incited  butter,  would 
form  a  suitable  breakfast.  Soup,  us  described  above;  some  well- 
mashed  potato  o]-  lish.  followed  by  a  vegetable  entree,  with  biscuits 
and  butter,  would  form  a  desirable  lunch.  Then  dinner  might 
consist  of  soup,  tish,  an  entree,  pudding  of  any  kind  not  too  rich  in 
eggs,  milk-puddings,  blancmange,  pustrv,  or  creams  are  permissible 
when  they  can  be  procured;  again,  biscuits  or  crackers  and  butter, 
with  a  nip  of  a  savoury  cheese  to  finish  with.  1  )essert  might  be 
liberal—though  1  am  afraid  some  of  the  older  practitioners  will  not 
approve  of  this  indulgence.  Then  if  some  food  were  required  later 
on.  a  plain  biscuit  and  a  glass  of  milk,  or  of  wine,  would  be  sufficient. 

()f  course  much  would  depend  upon  the  features  of  each  case. 
As  has  been  pointed  out  be.fore  in  these  pages — and  mav  possiblv 
even  be  refenvd  to  a^uin — it  is  not  what  is  consumed,  but  what  is 
digested,  that  is  the  measure  of  nutrition.  It  may  be  found  that 
even  where  some  meat  would  seem  indicated  bv  the  amemia  it  does 
not  attain  the  desired  end.  I  have  at  the  present  time  a  patient  at 
the  Victoria  1'ark  Hospital,  who  has  other  evidence  of  Plight's 
disease  than  mere  albuminuria,  in  whom  this  is  well  seen.  She  is  a 
well-built,  strong  woman,  but  pale.  So  sure  as  she  cats  anv  animal 
food,  so  certain  is  she  to  put  in  an  appearance,  complaining  of  not 
being  well,  looking  ill.  and  with  a  <|iiantitv  of  albumen  in  her  water; 
while  she  restricts  herself  to  farinaceous  food,  vegetables,  tish  and 
milk,  she  is  wed.  Again  and  again  -he  is  tempted  bv  some  foolish, 
well-meaning  person  to  take  some  meat,  and,  bein^  a  good-natured 
o  ..._•  ng  woman,  airain  and  again  has  sulTcred  for  her  compliance. 


••<  ><  >i>  IN   m;n  .in  -> 


Indeed    1    have    fiiuii'l    \vnli    a    certain    da^s    of    \   e-.ni-    in    I'.r 

disease  llial  a  milk  ami    farinaceous  dietarv  |  -n  i  ip''-m>"iied    I 

hath-)  has  not  only  cleared  tin-  urine  "f  aditimen.  !>nt   ha-  mad'-  ;iv 

siek    persons    feel    hfttlT. 

Stiii  then-  niav  occur  cast's  \vln-iv  fn>m  special  circumstance-;  •  • 
dietarv  niav  In-  relaxed  with  ad\  atita^e.  luit  llie  lilieralitv  -inni,d  '••• 
strictlv  watched.  And  i!'  there  lie  continuous  nie!:ta!  M  ra  M  this 
idionid  lie  [nit  in  alievance.  Then  a  modified  dietarv  nia\  ''•><•  e\- 
cusalile:  ainl  imlerd  of  advantage  to  i!ii-  individual.  Th-'n  a-  to  the 
use  nf  alcohol  in  I'.n^ht  's  disease,  opinions  dill'er.  Sonic  twelve 
year.- airo  the  matter  of  the  part  plaved  hv  alcohol  in  the  production 
of  1 5 1'li;' lit 's  disease  was  hot  Iv  discussed,  some  verv  eminent  ant  ltor:t  i--s 
takini:'  sides,  I  >f  course  it  nia\'  lie  laid  down  as  a  general  propn-i- 
tion  that  alcohol  has  a  liad  elTect  upon  ihe  liver  (no  one  u'iil  dc"v 
that  i.  and  that  then-fore  when  th'-  working  "f  the  liver  i-  impaired 
al'-oiin'i  is  cont  i-a-ind  icat'-d.  lint  tln-n  sometimes  a  little  aleohul 
ha<  a  heiietii-ial  ell'ect  it[ion  tin-  sv-tem  u'enerally.  and  it  ma\  lie 
(jUest  iom-d  how  far  it  can  1  >e  \viselv  wit hhclii.  especial Iv  if  no  nii\  .mis 
e\  ii  I'csuli  fp 'in  its  use.  Any  alliuminuric  can  lind  out  fur  him-" If 
if  h'-  cares  to  make  th.-  experiment.— that  a  certain  amount  of  alco- 
hol wid  send  up  the  proportion  of  al'unmen  in  tin-  urine:  though 

proliahlv    few    Will     lie  temple. i     to    test    t  lie  ;lecll  l';ic\    of    the    Statement 

in  their  own  persons.  Much  person  who  i<  the  snliject  of  liri-'ht'- 
disea^e  must  studv  the  matter  for  lnm-elf  or  herseif.  I  am  not  of 
opinion  that  it  is  well  to  makea  hard  and  fa.-t  rule  to  the  etl'ei-i  that 
under  no  cireumstanees  should  alcohol  he  taken  by  a  person  with 
chronic  renal  mischief.  This  would  lie  umvise,  lint  as  a  liroad 
rule,  it  mav  he  said  thai  when  genuine  liri^ht's  disease  is  on  I'oo'  i; 
is  wed  to  keep  a  strid  watch  over  the  amount  of  aleohul  taken. 
jn-l  as  it  i-  kept  over  the  amount  of  animal  food  consumed.  The 
ma'adv  is  found  amon^  water-drinkers,  and  therefore  h;i~  n»!  nece-- 
sariiv  an  alcoholic  oi-iLi'in.  All  the  same,  alcoholic  ind  nlu'eiiee  wil: 
a^-'jnivate  the  state  of  matters  when  it  exi.-ts;  and  there  are  few 
pei'Miiis  who  lake  niiieh  aleoiiol  who  do  not.  in  the  end.  ha\e  m1- 
chief  iii  t  hi-ir  k  idneys. 

\\  ithmil  iie^'at  i  VIIILT  other  casual  relation-.  ;i  mav  lie  si  d  t!!;i! 
the  dietetic  and  drinking  hahit-i  of  the  ind  i\  id  tin]  com  moi  \  1  \  p.a\  an 
importani  part  in  the  production  "t'  chronic  liri^iit '.-  .':  -ea*e. 

\\  itii  ,-onie  per.-ons  a  m;ds  dietarv  is  ellieient  in  ;';;:•;, 
to  the  sxinptoin-.  and  I  he  remo\al  «\  a, i m men  fj'"ia 
M  ,  i  is  cures  and  -jra  t  ><  •  >", ;  P--  a  re  ;n  \  o'j'iie  on  the  ('•>:;;:.'  as  m  I-.-;  P  •  i » -. 


11' I  MAM  A  I,    OK    IMKTKTlrs. 

To  remove  tin1  albumen  is  not,  however,  to  restore  tlie  kidneys  to 
:t  normal  condition.  Nevert  heless.  it  is  (juite  possible  to  stay  the 
progress  of  the  kidney  mischief,  and  to  arrest  its  march  by  wise  and 
judicious  measures,  of  which  a  careful,  regulated  dietary  is  a  factor 
of  cardinal  importance.  And  in  some  cases  it  is  possible  to  make 
the  advance  so  slow  as  not  to  be  measurable. 


CIIAPTKI!    XXIV. 

Fool)    IN    ALIU'MlXriIIA. 

IN  putting  albumiuuna  into  ;i  chapter  t>v  itself  inv  design  is  to 
emphasi/e  the  fad  thai  it,  and  Height's  disease  are  not  sviionvnioiis 
or  convertible  tenns. 

Albumuuiria  is  eonunoidy  enough  reallv  the  escape  of  peptones 
bvthe  kidnevs.  Instead  of  being  converted,  or  turtle1'!  l>ack  into 
proteids  in  the  portal  vein,  aquantitv  of  peptones  lind  then1  wav 
into  t  he  general  circulat  ion  and  slip  out  of  it  l>v  the  kiiinevs.  just 
as  ivadilv  and  as  easiiv  as  thev  found  their  \vav  into  it  l>v  I  he  portal 
venuies.  In  such  ease  the  system  is  ill  fed,  and  the  individual  is 
pallid:  and  a  condition  closelv  simulating  true  ISn^ht's  disease  is  set 
up.  Such,  indeed,  usually  are  the  eases  of  Uright's  disease  which 
are  "cured;"  for  the  real  disease  (as  spoken  of  in  the  la.-t  chapter) 
does  not  admit  of  cure.  Conditions  of  acute  ''  I>ri^ht's  disease" 
are,  however,  compatible  with  recoverv:  leaving  the  kidtievs  eit  her 
free  from  permanent  injurv,  or  in  a  more  or  less  disabled  condition. 
Thus  the  consequences  of  scarlatinal  nephritis  are  most  varied. 
Kveii  more  permanent  states  are  compatible  with  considerable 
length  of  days.  But  wit h  conditions  \vheivthe  presence  of  albu- 
men in  t  he  kidnevs  is  not  accompanied  by  co-existing  evidences  of 
perturbed  health,  the  prospect  is  i'ar  less  grave. 

The  following  is  an  illustrated  case  in  point:  A  patrician  youth, 
who  like  manv  others  of  his  class  indulged  a  good  appetite,  had 
albumen  persistently  [iresent  in  his  urine.  A  hastv  medical  opinion 
to  the  ell'eet  that  he  had  "  I  >right 's  disease  "  was  ai'i'e[ited  by  his 
familv;  and  in  so  far  he  was  an  object  of  interest  to  a  large  circle  of 
friends.  One  dav,  when  riding  in  a  London  park,  he  met  with  an 
accident,  and.  breaking  a  limb,  was  taken  to  a  neighbouring  hospi- 
tal. There  he  was  put  upon  the  ordinarv  d  let  arv.  with  ihe  iv-n't 
that  he  lost  his  albuminuria.  The  case  was  i^reatlv  discussed  in 
polite  circles  as  a  "  wonderful  cure  of  Bright 's  disease."  This  is  an 
instance  of  the  loose,  inaccurate  gossip  that  u'oes  on  about  diseases 
all  over  the  world. 

\Vheti  a  diet  is  too  rich  in  albuminoid  matter   the   urine  is  apt  to 


J'.M'I  MAM'AL    OF    DIKTKTICS, 

be  albuminous.  \\  hen  such  albuminuria  exists,  it  is  but  reasonable 
to  suppo.-e  that  some  modification  of  the  dietarv  is  desirable.  First, 
however,  ascertain  what  the  precise  facts  are.  and  if  the  dietary  is 
really  too  rich  in  albuminoids.  If  this  be  so.  it  is  well  to  reduce 
the  amount,  and,  put  the  patient  upon  farinaceous  matters,  fish, 
fruit  and  fat.  The  whole  matter  wa-  too  thoroughly  ^one  over  in 
the  laM  chapter  to  nerd  repet  it  ion  here. 

If.  on  the  other  hand,  there  is  evidence  of  mal-nutrit  ion  present, 
it  mav  be  well  to  combine  a  liberal  dietarv  with  a  course  of  tonic, 
and  hu'inatics. 

Mi-re  albuminuria,  as  differentiated  from  l>i'i gilt's  disease,  is  not 
a  bodily  trouble  which  calls  for  special  dietetic  treatment,  beyond 
what  has  just  been  said  above.  If  too  much  labour  m  the  digestion 
of  albuminoids  has  been  thrown  upon  the  digestive  organs,  then  we 
mav  find  the  nitro^enised  matters  slipping  away  in  some  form  of 
albumen,  just  as  they  may  lie  cast  out  as  some  imperfect Iv  oxidised 
form  i  if  urina  rv  prod  net. 

I  udeed  the  whole  t  feat  iiieiit  of  a  case  of  album  iniiria.  alike  medi- 
cinal and  dietetic,  will  turn  upon  the  diagnosis;  ;md  for  accuracy 
greater  pains  are  desirable  than  are  ii-uallv  bestowed  upon  it.  too 
commonly  the  worst,  benr_r  rashly  luss.umed. 


CTTAPTFJi    XXV. 

TIIK    I-'()(  )|>  IN    DIAIJKTKS. 


IF  tin-  dietetic  indications  in  mere  albuniinuria  arc  compara- 
tively un  mi  port  a  nt.  I  In-  case  is  widely  dill'eivnt  in  d la  betes  niellit  us, 
where  they  are  of  the  gravest  importance. 

In   diabetes  the    patient    Wastes    hecause   the  ^rape-si  i 'jjar.    the   food 

of  the  body,  is  slipping  awav  livthe  kidneys  and  so  is  unavailable 
for  the  hodv-needs.  It  is  not  t  lie  presence  of  t  lie  stiLrar  in  the  urine 
which  is  of  importance,  though  it  would  seem  like  it  from  the  atti- 
tude of  a  considerable  section  of  the  medical  profession.  The 


his  hodv  is  starving,  and  he  is  tortured  by  the  symptoms  set  up  by 
the  presence  of  an  excess  of  ^rape-suLrar  in  his  hlood.  An  urgent, 
thirst  impels  him  to  drink  copiously  to  wa-h  this  excess  out  of  his 
system.  There  is  some  prospect  of  success  in  dealing  with  a  .salt- 
thirst  by  drinking:  but  with  a  suu'ar-t  hir.-t  the  ease  is  widely  dill'er- 
ent.  jus  anyone  who  1ms  had  experience  of  it  well  knows.  The  dis- 
teiition  of  the  vascular  system  adds  to  the  blood-pressure  in  the 
hepatic  arteries,  and  so  increases  the  output  of  siiu'ar  from  that 
viscus.  The  sutFeritur  patient  drinks  and  drinks,  and  UTOWS  worse 
and  worse  too  frequently:  and  unless  some  impression  can  he  ma<ie 
upon  the  functional  disturbance  in  the  liver,  the  case  --oes  ,>u 
from  had  to  worse  until  the  final  end.  In  other  eases  the  pi-o-ji-os 
is  less  disastrous,  and  by  proper  dietetic  arrangements  the  patient 
keeps  the  maladv  at  bay  and  lives  on.— a  harassed  and  much  •:  Ked 
creature.  In  other  cases  a  better  career  is  found,  the  "diabetic 
storm  "  passes  over,  leaving  a  comparative  cairn  behind:  where  then- 
is  more  or  less  siiu'a  r  in  the  urine  cont  in  uou  s;  y.  hut  rarel  v  an  v  SVIH  p- 
totiis  ,,f  diabetes.  In  such  eases  aiiv  disturbance,  a-  a  shock,  or  an 
access  nf  \\-orry,  mav  hnni:  on  an  acute  diabetic  attack.  Such  are 
then  t  he  variet  ies  of  what  mav  fairly  be  termed  "  I  liabetes  "  a-  com- 
pared to  mere  "  <  T  ]  \"eos|| ria.  " 

It  is  well  to  hear  the  distinction  in  mind  when  ..«•;(!•  .rh  :tnv 
individual  ca.se  u  hen-  stiirar  is  present  in  I  tie  u  r:  nc. 

In  the  manau'eineiit    of  dialietes  proper  the  diciarv 


I'.'S  MANUAL    OF    DIKTKTK 'S. 

cardinal  importance.  Bv  indulgence  in  anv  food  -which  will  form 
UTape-suiiar.  or  rather  from  which  grape-sugar  can  be  formed,  a 
distinct  aggravation  of  the  symptoms  is  at  once  set  up.  All  carbo- 
hvd rates  must  lie  earefullv  avoided.  The  consequence  is  that  11  rigid 
dietarv  must  he  laid  down  hv  tin-  medical  man.  and  observed  hv 
the  patient.  Indeed  the  latter  is  only  too  glad  to  secure  relief  from 
the  torturing  thirst  endured.  The  dietary  preserves  the  organism 
from  perishing  of  exhaustion  until  the  disturbance  which  sets  up 
thediahetes  isahated.  if  ahatement  he  feasihle.  U\*  supplying  food 
material  which  does  not  form  grape  sugar,  two  distinct  ends  are 
served  - 

1.    The  organism  is  fed;  also 

'.'.  The  sull'ering  caused  hy  the  presence  of  sugar  in  excess  in 
the  hlood  is  relieved. 

These  are  great  matters,  truly.  Hut  thequestion  may  lie  raised: 
—  Dot's  a  strict  dietarv  exercise  anv  curative  elTect  over  the  malady;* 
Does  it  merely  keep  the  patient  alive  till  a  cure  is  wrought?  Or 
does  it  tend  directlv  to  that  end? 

If  we  believe  in  '*  physiological  rest  "  to  anv  organ  impaired  or 
injured,  or  functionally  incompetent — and  such  a  hroad  rule  is 
recognised  in  medieim — -then  the  non-carbo-hydrate  dietarv  lias  a 
instinct  curative  tendency.  Physiological  rest  as  regards  its  glvco- 
geiiie  function  must  favour  the  regaining  of  its  lost  or  weakened 
power  li\-  the  liver.  It  is  at  least  a  reasonable  assumption,  even  if 
it  cannot  lie  demonstrated  as  a  proved  fact.  Such  assumption  falls 
MI  with  one's  experience  on  other  matters  medical. 

\\here  carbo-livdrates  are  eontra-ind'.eated,  then  we  tind  the 
dietarv  rest  ricted  to  hvdro-carhons  and  albuminoid  with  the  alcohols, 
a-  ordmarv  alcohol  or  spirits  of  wine  and  the  alcohol  v;lvcerine. 

The  chemist  has  striven  to  give  directions  to  the  baker  in  this 
matter,  and  hv  depriving  wheaten  Hour  of  its  starch,  a  gluten  bread 
is  made  which  can  be  eaten  with  butter,  (iluteu  bread  is  not  par- 
ticularly acceptable  to  the  palate,  still  with  salt  butter  it  is  not  very 
objectionable.  Some  gluten  biscuits  are  the  most  unpalatable  food  I 
hav  ever  ta-ted  in  a  wide  raiiLfe  of  experience.  Nothing  but  a 
mo  ust  roii-  fear  of  deat  h.  or  some  ti'em  end  on  sly  strong  mot  ive  to  live, 
could  enalile  ativ  one  to  get  th''iu  di>wn. 

Then  the  od  of  the  almond  i.~  utilised  as  formed  in  almond  tlour, 
and,  -till  more  in  almond  biscuits.  These  are  palatable  enough,  and 


KIM  )| )    IN    DIAMKTKS.  I'.i'.t 

which  throw-  a  strong  ii'j'ht  on  the  ^niesis  of  diabetes.  Talking 
one  d:iv  with  .Mf.  \  an  Abbott,  who  is  so  we'd  known  in  concretion 
wall  almond  food  t'nr  diabrte<,  I  a-krd  rasuallv  -"Who  an-  vour 
chief  cu-!oniers.  Mr.  \'an  Abbott?"  His  face  assumed  an  earne-t 
look  as  lie  replied.  gravel  v  "  ( .  iv\ .  worn,  business  men  look i MIT  > >'.<\<-r 
tlian  tln'ii-  vears."*  The  alnioinl  liiscuit  is  rich  in  nil  and  tlifivl'niv 
i'lirms  an  iidiuimhlc  "  furl-food."1 

Thru  of  course  1m Ik  ;s  grateful  to  t  hr  stomach  and  musi  lie 
sought  in  the  parrii'-livma  of  vegetables. 

Defoi'r  proci'i'ilint;  to  t  hr  practical  discussion  of  the  food  of  the 
diabetic,  h,  mav  be  well  to  irivr  \)\-.  1'avv's  table  of  the  vai'ious  food-: 


HutcluTs"  meat  of  all  kind-,  except  liver,  ham.  bacon,  or  other 
smoked  sailed,  oi-cured  meat-.  1'oultry.  ^ame.  -hell-fish  and  !i>h  of 
ail  kinds,  fi'esh.  salted  or  cured.  Animal  soups  not  thickened,  beef 
tea  and  broths.  The  almond,  bran  or  gluten  substitute  for  ordi- 
nary bread.  Kirn's  dressed  in  anv  \vav,  cheese,  cream  cheese,  but- 
ter, cream,  (ireeiis.  spinach,  turnip-tops.  French  beans.*  ]>)ru--el- 
sprouts.*  turnip-.*  rauii (lower.*  broccoli,*  cabbage,* asparagus,*  -«-a- 
kale/::  vrirrtalili'-rnun'ow,*  mushrooius. 

(Those  marked  with  an  a-tcri-k  mav  onlv  lie  eaten  in  moderate 
(jiiantitv.  and  should  be  boiled  in  a  lar^e  (jiiantitv  of  water). 

\Vatcr-cress,  mustard  and  ere-s.  cucumlier.  lettuce,  endive. 
I'ailislies.  celery,  vinegar,  oil,  pickles.  Jelly  tluvonivd,  bin  not 
sweetened,  savou rv  jel  1  v.  blanciiui n u'c  made  with  ci'cam  and  noi  m  ,1k . 
custard.-  made  without  .-u^ai1.  Nuts  of  anv  description,  except  clii-s- 
nuts.  (  Hives. 


kinds.      uicr,  arrowroot,  sairo,  tapioca,   inai'caroni,   vermicedi.    [iota- 
toes,  carrots,  par-nip-,  beet-root,  pea-.  Spanish  onions. 

I'a-tryand  puddings  of  ad  kinds.      Fruits  of  ad  kinds,  fresh  and 

[.reserved. 

'•'•  i  1 1   1  he  a-,- 1  n  i,i  t  i,  ,n    I  iei  -,\  i  \  1    |  ii  -i  -1-1 1  -ii  1    mental    -!  r;t  i  ii  a  ml    .. .  a*  •    . . .  \    :n 
rrea^iiii:  el  ia:  »-l  e-.  \\  e  ;ire    i  >.••_:  i  11  iim_'  to    have   -.  -;i  !••  Ii  irnii-,1  , .  |  -i  i: :,  i ,  -.  -  - , .  .1  ;m 

all'eaiK'    rxi-t       Ili-tWJXl       -''Hie      -Miili'll     --Illli-k     allll      llie     iJllieK      lleVeji  '|i!ll.-|ll      of 

aci  lie  ilia  In1!  ic  -\"h  1 1  it  <  'in-. 


1'fio  MANfAl,    OK    DIKTKTICS. 

MAY     Hi;  INK 

Tea.  mlTco.  cocoa  from  nibs.  Dry  sherrv.  claret,  dry  Sauterne. 
Burgundy,  ('liablis.  hock,  brainlv  ami  spirits  that  have  not  been 
sweetened,  soda  water.  Imrton  bitter  ale  in  moderate  quantity. 

M  I'ST    AVOID    DIM  N  K  1  No 

Milk,  except  spannudv.  S\veet  ales-  mild  and  old— porter  and 
stout,  eider,  all  sweet  wines,  sparkling  wines.  Port  wine,  unless 
sparinu'iv.  Liqueurs. 

Such  is  a  fairlv  complete  list  of  foods  forbidden  or  permissible. 

()f  course  all  the  pivdiu'ested  carho-hyd rat es  as  prepared  foods 
are  contra-indicated.  However  valuable  elsi'where.  thev  must  be 
banned  from  the  diahetie's  dietary.  On  t  he  ot  lu-r  hand,  all  oil  emul- 
sions can  be  cordially  accepted. 

All  fishes  preserved  in  oil  form  admirable  food. 

With  Dr.  Taw's  material  to  hand,  it  is  possible  to  construct  the 
diH'crent  meals  of  the  day.  it  not  bcin^  necessary  to  have  all  the 
articles  mentioned  upon  the  table  at  once.  A  variety,  of  course, 
mil.-t  be  provided. 

HIM:  A  K  FAST. 

Tea.  coil'ee  or  cocoa  with  cream,  gluten  bread  and  butter, 
a  1m 01  id  biscuits,  tish.  with  oil  or  melted  butter,  caviare,  mutton-chop, 
rasher  of  bacon,  cold  meat.  ham.  pi  me.  pressed,  beef,  tongue,  water- 
ITess.  salad.-  pickles. 

LfNCll. 

Soup,  lobster  saiad.  potted  trout,  celerv.  raw  or  cooked,  radishes, 
scrambled  ej^s.  cream  clieese.  ('iaret.  hock  or  sherrv. 

DIN  N  1:1;. 

Salmon,  with  lobster  sauce,  brill,  anchovv  sauce,  coil,  shrimp 
sauce,  herrings,  suuec  tartar,  plain  white  fish  and  incited  but- 
ter, troul  with  parsley  butter  (not  ilour  (la-te).  stcxved  mushrooms. 
pi.irs'  feet.  A  joint  of  iinv  kind  \\'ith  spinach,  caliba^-e.  catiiillowcr. 
|Jnis-e,-  -pro',,1  .  .  celerv.  endive  or  encumber, 

/;'n/r  1 1*.        Sweet  lil'i'ad-.     pi^'s"    or    calves'    check     boiled,     then    cut 

ill  pieces  and  served  up  with  a  since  piquant.      Mavoiuiaisc.      (lame 
of  all  kind  -. 

>a,ad    and    cheese,    cream  .    ;  lekles.        ('reams    (unsweet- 

I  ilnten  bn-ad.     •  1   chec~c.  al  tuoiii  1  liiscuit  -.    claret,    hock. 


FOOD  IN  DIAHKTK." 


Piv  such  means,  variety — so  essential  t<>  the  [lalate— can  lie  -e- 
cured,  and  an  ample  suHiciencv  for  the  nutrition  of  the  Unix-,  too,  is 
furnished. 

And  no\v  to  some  criticisms  of  the  ri^id  dietarv: 

In  the  lirst  place.  I  )r.  1'avv  bans  liver:  vet  he  allows  shell-tish. 
though  the  oyster  and  the  mussel  consist  lar^elv  of  liver.  This  is 
ohviouslv  onlv  an  oversight. 

'I'hen  do  not  turnips  contain  some  supir?  He  states  thev  do. 
That  is  another  oversight. 

The  more  serious  criticisms  are  these:— Is  it  ahvavs  desirable  to 
subordinate  the  dietarv  to  the  diabetes;'  Are  not  sometime-;  slight 
diveruvn-vs  from  the  rule  permissible?  Though  milk  docs  contain 
suu'ar.  is  it  alwavs  advantageous  to  bar  it?  Of  course  when  the 
patient  is  Bravely  ill,  any  addition  to  the  su^ar  in  the  blood  is  otl'en- 
sive  and  objectionable:  but  when  the  condition  is  less  pronounced 
sometimes  milk  mav  lie  allowed  freelv.  and  the  >anie  mav  be  said 
about  ordinarv  bread.  In  one  case  latelv.  where  the  patient  chafed 
at  the  riu'id  di-'tarv,  a  little  bread  came  in  advantaireouslv.  The 
relief  it  u'avc  to  his  stomach  more  than  counterbalanced  the  extra 
su^ar  in  t  lie  svstem. 

lint  of  course  such  deviations  from  the  rule  should  be  narrowlv 
watchi-d.  and  with  a  full  consciousness  on  the  patient's  pan  that  the 
cha  Hire  is  an  experiment  which  mav,  or  ma  v  not .  turnout  successful  I  v. 
\\"hat  the  writer  desires  to  put  clearlv.  if  he  can  achieve  this,  ; 
"That  whde  it  is  neccssarv  to  adopt  a  riirid  dietarv  in  ixrave  cases 
of  diabetes,  and  when  acute  svmptoms  ;ire  present,  is  11  necessarv 
or  desirable  to  pursue  sueh  dietai'v  when  the  svnipumis  are  ijuies- 
cent  :'  Is  it.  or  H  11  not.  the  fact  that  manv  persons,  fairlv  to  tie  re- 
garded as  diabetics.  siitTei1  much  IIKU-C  from  tlieir  ilietarv  than  their 
malady,  and  that  manv  break  bounds  without  apparentiv  ^ulVerin^1 
m  I'onsefpience  thereof?  The  histories  related  bv  various  patients 
\\'oiiM  |'a\i»ur  this  view  in  numerous  instances.  But.  all  the  -ame, 
-•ivat  caution  should  be  exercised,  and  the  etl'ects  of  each  foi-b;dden 
art  i'-!'1  be  narn >wl  v  wat '-bed. 

The  patient   mii-t   be  dieted  in  order  to    be    kepi  ;iii\  •    unti.  the 
livei1  can  regain    its    iost   power  as  regards  it-  ^-!\i-o^i-n:e 
possible.       Hut   how  i-   this   I,,  l,e  attained  ':      It    i>  i;ot    merc,\    bv  t  he 
a\'oida nee  of  suLi'ar  and  \\  ha '  will  make  -u^'ai'.     '1  he  plan  ,  n  \  •'•_•'' ie  -o| ne 
\  e;i  |-s  ;i  -•,  i.  k  nowi;  a  -  "t  he  sk  im  -mi  i  k  t  real  n  lent  oi  d  a  i  »•'>•-.     ad  \  oc;i  1 1  -d 


"2(1'2  MAM'AL    OF    DIKTKTK'S. 

vigorously  l>y  I>r.  Scott  I'onkin,  had  ;i  lar^e  measure  of  success;  and 
vet  the  milk  su<_rar  was  nut  removed  in  the  cream.  The  actual 
amount  of  suirar  had  something  to  do  with  the  result.  I  feel  certain. 
A  u'lvcosunc  patient  of  mine  recent Iv  sent  me  a  sample  of  her  urine 
for  examination  which  was  absolutely  free  from  sn^ar.  Vet  at 
that  time  she  was  Imnv,'  upon  vermicelli  pudding  and  arrowroot  — 
two  farinaceous  matters  most  likely  to  have  produced  an  excess  of 
suurar.  There  seems  some  ground  for  holding  the  view  that  the  liver 
can  deal  normally  with  a  certain  amount  of  su^ar,  and  a  certain 
amount  onlv;  and  anv  excess  beyond  this  remains  in  the  blood, 
Lfivinir  rise  to  diabetic  symptoms.  Hut.  the  subject,  is  one  on  which 
li_rht  is  coniinir  in  slowlv.  and  time  must  elapse  before  we  can  see  it 
in  the  full  day-liirht  of  complete  knowledge.  Some  years  a^o  a 
retired  armv  medical  otlicer  of  eminence  consulted  me  for  severe 
attack-  of  angina  pectoris,  and  on  examination  he  was  found  to  have 
a  ^oiitv  heart  with  disease  at  the  aortic  valves.  On  taking  down 
hi-  history  it  turned  out  that  some  years  previously  he  was  (in  India) 
tc-tinL:  the  urine  of  a  patient  for  suvjar.  lie  was  in  perfect  health 
and  strength,  and  wishing  to  be  sure  of  his  tests  he  determined  to 
examine  the  suspected  urine  side  by  side  with  his  own.  To  his 
astonishment  he  found  his  own  urine  heavily  laden  with  suiiar.  So 
alarmed  was  he  that  he  made  all  haste  home  to  put  himself  under 
an  eminent  a ut  hority  on  t  he  subject  of  diabet-s.  (  Mi  this  his  health 
soon  he^an  to  fail  in  reality,  and  after  some  months  he  pvw  so  weak 
and  ill  that  he  be^vd  for  some  raspberry  jam.  a-  lie  could  not  be 
worse  than  he  \vas.  His  re<|uesi  was  complied  with,  and  he  felt  the 
better  of  the  carbo-hydrate:  and  the  result  was  lie  pive,  up  his 
dietary,  ate  and  drank  what  lie  pleased,  and  ^'ot  well:  ultimately 
losing  his  ^Iveosuria  entirely.  There  was  no  grounds  for  question- 
ing the  truth  of  his  narrative;  lie  \vas  a  man  of  known  probity,  be- 
loiiLrinir  to  a  distinguished  family.  It  is  a  curious  fact,  that  several 
brothers  of  this  family  have  at  times  passed  .-ULrar.  They  are  all 

Vj  'lit  V, 

Iii  what  has  just  been  written  it  is  not  intended  to  cast  doubts 
upon  the  value  of  a  nun-saccharine  dietary  in  diabetes  that  would 
be  absurd:  but  to  point  mit  that  we  have  vet  much  to  learn  about 
the  conditions  under  which  siiLTar  appeal--  in  the  urine.  Of  the 
\aluc  of  a  suitable  dietary,  not  onl\  as  ;i  mean-  of  fnnii-liinu'  relief, 
a  stcppiiiLT-stone  towards  cure  :n  man\'  ca-e.s,  there  can  exist 
lid  doubt.  Indeed  m  diabetes  m>  .. .::;-  we  see  one  of  the  nio-t 
marke  :  instances  of  the  value  of  dietetic-,  and  of  tin.1  foo«l  treat  men  t 


CIIAPTEK   XXVI. 

'FO()I>    IN    <;  L  V  COST  K  I  A. 

TIM:  mum  reason  for  the  existence  of  this  <>h;ij)tcr — as  a  separate 
chapter  rather  than  us  un  appendix  to  the  last  chapter  -is  to  keep 
(rlvcosuriu  well  apart  from  true  diabetes.  There  exists  such  an  un- 
fortunate entanglement  of  the  l\vo.  not  only  out  of  the  medical  pro- 
fession but  even  within  its  ranks,  that  a  complete  divorce  of  the  two 
is  most  desirable. 

( i  Ivcosuriu   is  oolite  common    with  corpulent    persons,   especially 

where    Millie     ";out    IS    present.        Ill    such     persons,    indeed.    It     Seem-    a 

species  of  waste-pipe  runniM";  oil'  the  surplus  carbo-hydrate-,  and 
without  which  the  body  would  become  embarrassed  with  an  accu- 
mulation of  fat.  Indeed  the  laying' on  of  fat  from  the  surplus  of 
carbo-hydrates,  while1  a  condition  of  ^Ivcosuria  is  co-existing,  is  not 
unknown. 

A  marked  instance  of  this  came  under  my  notice  about  a  year 
airo.  when  a  series  of  experiment  -  with  prepared  funds  (consist  HILT 
mostly  of  prediiresled  starch),  inslead  of  increasing  the  out-put  of 
suirar.  resulteil  in  a  marked  increase  in  weight. 

\Vhat  the  relations  of  "/out  and  <rlyeosuria  are  we  do  not  precisely 
know.  The  one  is  a  disturbance  of  the  idvco^vnie  function  of  the 
liver,  the  other  of  the  second  function  of  that  important  viseiistiie 
metabolism  of  albuminoids.  There  is  sonic  linked  association  ev;- 
<leiitiv.  though  what  its  nature  is  still  shrouded  from  us. 

On  the  other  hand,  one  of  the  ".Teat  dangers  connected  with  the 
abundance  of  animal  food  allowed  in  cases  of  diabetes  and  i^lveo-qir.a 
i-  the  production  of  interstitial  nephritis,  or  I!ri";ht's  disease.  There 
is  no  proof  that  siiLfur  in  pas-m^  out  of  the  kidneys  doc-  any  injury 
to  those  organs,  any  more  than  it  does  to  the  portal  vein  by  \\li.cii 
it  enters  the  circulation  at  every  meal:  but  the  lar^e  amount  of 
ai!  Hi  in  inoids  not  only  allowed  but  positively  forced  upon  t  he  -  ,  \  ci  >-- 
uric  patient  i-  certainly  destruciiye  to  the  kidney-.  Tli:-  i-  ihe 
ot  her  asjicci  of  fond,  vi/..:-  seeinu'  that  we  do  not  do  harm  \\.ih  it. 
It  is  not  wed  to  engraft  a  slate  of  permanent  injur\  to  i  he  kiiitievs 
iiiion  a  condition  of  Li'lvco^uria,  which,  as  vet  at  lea.-t.  is  not  con- 


•-'"4  MAM'AL    OF    DIKTKT1CS. 

victed  of  evil,  even  if  it  have  been  under  some  suspicion.  That  is 
the  substitution  of  a  morbid  certainty  for  what  is  so  far  nnproven. 

There  are  not  onlv  the  lienetits  to  he  derived  from  a  correct 
dietary  in  certain  maladies;  there  is  the  harm  whieli  may  accrue 
from  dietetic  error.  The  kidnevs  are  far  from  being  hevond  sus- 
jiieion  in  goutv  persons  of  middle  ago,  and  if  a  liberal  meat  dietarv 
IK-  adopted  there  is  a  distinct  and  measurable  danger  of  a  Cravat  ing 
the  renal  trouble — a  most  undesirable  matter.  The  patient  must 
choose  (under  medical  direction)  what  he  will  do,  whether  lie  is 
more  afraid  of  the  pint  or  the  glveosuriu;  and  if  he  is  a  prudent, 
thoughtful  man  he  will  choose  the  glyeosuria — as  the  less  evil  of  the 
two. 

If  the  teaching  of  this  chapter  be  mainly  negative,  it  is  not, 
then-fore  without  its  value. 


CU APT E ft    XXV IT. 

TIII-:  !•"  < » <  >  i )  i.\  cor  T. 

BFFOKI:  proceeding  to  the  subject-matter  proper  of  this  chapter, 
it  niav  he  well  to  clear  the  ground  somewhat  as  in  what  is  meant  hv 
the  term,  "gout."  It  once  IKH!  a  definite  meaning,  and  was  applied 
onlv  to  the  deformities  of  the  small  joints  of  the  extremities  cau-ed 
hv  the  deposits  of  urate  of  soda  in  the  articular  cartilages  of  the-e 
joints.  'I'liey  were  produced  r/m/f/r  fii'i"  t/nt/f/i\  that  is  "drop  by 
drop. "  So  long  as  our  ideas  of  gout  were  restricted  to  t  hese  ohvious 
morhid  changes  all  knew  what  was  meant  hv  the  term. 

I5i  it  when  t  lie  chemist  discovered  that  the  said  deposits,  or  "  chalk 
stones,"  consisted  of  urate  of  soda,  the  word  hegan  toha\e  an  ex- 
tended meaning,  (lout  was  seen  to  he  a  blood-disease,  /.>..  that 

uric  acid  (as  unites)  circulated  in  the  hi 1.  and  wherever  the  bloud 

circulated  there  might  gout  follow.  For  instance,  it  was  found  that 
goutv  deposits  were  laid  down  in  the  valves  of  the  heart  just  a- 
much  as  in  the  joints  of  the  lingers  and  toes.  1  rate  of  soda  H  com- 
monly formed  in  nodule-  on  the  pinna'  of  the  ear  I  <  Molite<.  )  1 5  run - 
chilis  lias  heen  found  often  to  have  a  basis  of  gout.  Certain  -kin 
diseases  were  recognised  as  having  goutv  associations,  'Then  various; 
disturbances  of  the  action  of  the  heart  have  been  discovered  as  heni'j; 
outcomes  of  gout.  Thus  the  range  of  the  term  was  found  to  be 
constantly  extending.  From  uric,  otherwise  lithicacid,  bein'_r  th" 
iiiiili'i-ii1*  i  ii  "I'lii  of  i^out .  the  terms  "  lit  hia  sis  "  and  "  1  it  lia-mia  "  have 
been  used  to  de-ignate  t  he  gout  v  condit  ion.  They  are  more  accurate 
terms,  hut  it  will  take  smnc  time  for  the  public  to  become  familiar 
with  them:  whereas  the  vagaries  and  internal  complications  o|  gout 
are  fairly  generally  known. 

Tiie  various  foods  of   the  hodv,  whether  Fuel-food  or  t  ;-sue-food. 
undergo   within    ii    an    oxidising    process    which    produce 
I'oive.      The  fuel-foods   burn  easily:    the    t  issue-mat  ters  o\i. 
diHieultv.       Worn-out    tissue    and    surplus    tissue-material     undergo 
ret  ro^rade  changes  which  tit   t  hem  for  e \cp-t  iou  by  l  he  kidiie\  <.  and 
to  a    less  extent  by  the  skin.      These   changes   take    place  to  a  irreat 


•JHt;  MANUAL    OF    D1KTKTICS. 

extent  in  the  liver — (lie  furnace  of  the  body — the  resultant  products 
beiuir  cast  out  liv  the  kidnevs. 

When  kidneys  first  make  their  ;i})po;iranco  in  tin- animal  world 
\ve  liml  the  form  of  nitro<renised  waste  to  he  uric  acid.  Uric  acid, 
as  urates.  belontr  '"  aniiiials  with  a  t  hree-ehaiuhered  heart  and  a 
solid  urine.  /'.'..  hirds  and  reptiles.  When  the  mammalia  appear  we 
find  a  t'our-chainliered  heart  and  a  iluid  urine.;  the  form  of  nitro- 
trenised  waste  beintr  the  soluble  urea.  There  st ill  remains,  however, 
traces  of  the  primitive  urinary  product,  uric  acid.  So  lontr  as  the 
liver  can  convert  the  waste  and  spare  albuminoids  into  the  soluhle. 
urea  all  is  well.  As  the  soluhle  urea  the  excrementitious  matter  is 
trot  rid  of  without  difficulty,  and  albuminoids  far  in  excess  of  the 
hody-needs  can  be  eaten  with  impunity.  Hut  when  the  liver  fails 
in  the  formation  of  urea,  and  reverts  to  or  falls  hack  upon  the 
primitive  uric  acid,  a  change  conies  over  the  scene.  The  compara- 
tively insoluble  uric  acid  lingers  in  the  blood,  finds  a  habitat  in  the 
articulations  of  the  extremities,  in  the  valves  of  the  heart,  on  the 
pinna-  of  the  ear,  while  it  irritates  the  air  passages  and  teases  the 
skin.  A  certain  proportion  finds  an  exit  bv  the  kidnevs,  and  worries 
these  orpins  into  interstitial  nephritis,  known  as  the  cirrhotiu  or 
polity  kidnev. 

At  other  times  the  condition  assumes  ;i  complexion  which  en- 
titles it  to  be  designated  Chronic  Britrht's  Disease. 

When  urates  are  formed  bv  the  liver  one  of  two  things  bappens: 
1.  the  urates  are  cast  out  by  the  kidneys,  which  become  injured  bv 
this  out-put,  and  chronic  kidney  disease  is  set  up:  or  '.'.  the  uric 
acid  remains  within  the  svstem.  trmntr  trout  (in  some  of  its  many 
forms):  or,  as  very  frequently  happens,  somewhat  of  both  occurs, 
as  has  been  said  before. 

From  this  we  can  understand  what  is  meant  bv  "the  trout v 
habit"  or  "a  trout  v  man"  or  "latent  trout,"  and  realise  that  the 
individual  is  the  subject  of  hepatic  reversion,  with  a  tendenev  to  the 
formation  of  uric  acid.  We  can  also  comprehend  what  is-meant  bv 
"vjuitv  families."  and  whvCiillcn  railed  trout  "  .!A./7///\  ll>T<'dit«- 
/•/">."  \\hi'ii  iheiv  has  been  trreat  indulgence  in  animal  food  for 
generations  tin-  liver  becomes  more  or  le.-s  worn  out  bv  its  toil,  and 
t  he  M' ion  of  such  a  familv  starts  li  1'e  with  an  insu  (lie  lent  liver.  "  The 
children  of  trouty  parents  ou-ht,  more  espeeiallv  to  follow  the  hv- 
Lrienie  and  dietetic,  laws  laid  down  in  these  patres  (••  \utrition  in 
Health  and  l'isea-e")  if  thev  wish  to  escape  much  suH'emur.  Asa 
rule  thev  ou'_rht  to  be  wat er-d ri n k crs  throughout,  life.  Thev  have 

to     pa  V    the    penaltVof     their    pro-Jet  i  1 1  ol'S*   excesses     Of     dietetic     effoi'S. 


FOOD  IN  <;<>rrr.  I'M 7 

If  tin-  £<>utv  diathesis  is  stronirlv  niarki-d.  thev  should  In-  mo-: 
moderate  and  abstemious  in  their  fund  habits,  and  l<  ad  a-  active  ai.d 
nnisi'ular  a  life  as  possible."  (.lames  Ih'nrv  l>eiiiiett).  Whiie.  on 
tin-  n!  her  hand,  the  huiidily  born  alderman  who  -tarti-d  life  with  a 
liver  in  all  its  inteirritv.  cats  and  drinks  with  impunitv  into  »\>l  a^e 
before  his  Nemesis  overtakes  him:  or.  perhaps,  himself  escapes 
free  to  leave  a  tendeiiev  to  pmt  aloir.:  with  his  wealth  to  his  descen- 
dants. 

l!v  sueli  consideration  of  irout  (in  tlie  widest  sense  of  the  word 
we  can  all  the  better  understand  t  lie  food-rec|iiirenieiits  of  persons 
artlicted  with  this  tendencv  to  form  uric  acid.  What,  the  relations 
of  uric  acid  are  to  "  lilue  blood  "  it  i<  impossible  to  sav  deiinitelv. 
but  both  run  in  the  veins  of  lon^-deseended  patricians,  (iout  has 
had  a  history  of  p>od  eatinirat  some  time  in  the  historv  of  the  in- 
dividual or  his  race.  The  liver  has  become  impaired  bvthe  labours 
it  has  had  impo.-eil  upon  it  for  generations.  And  this  liver-failure 
brings  with  it  in  its  wake  all  and  sundrv  of  tho.-e  di -agreeable  eon- 
sei jiieiiees. — the  various  and  numerous  forms  of  u'oiit.  It  also  points 
out  to  us  in  an  unmistakable  manner  the  food  to  be  adopted  1'or  the 
relief  of  this  tendency  to  form  an  excess  of  Uric  acid. 


LOXDOX   KKYKi;   HOSPITAL. 
DIKTAKY  TABI.KS. 


ADULTS. 

l.  •-'. 

Milk,  ','i  Pints.  Milk,  -Ji  Tints, 

liivail,  Ki.^ht  Ouiic.-s.  Bread,  Ki-'ht  Ounces. 

:}.  4. 

Milk.  Two  Pints  and  Half.  Milk.  Two  Pints  and  Half. 

Beef  Ten.   (  )lle  Pint.  Beef  Tea.   (  >lle  J'illt. 

Two  K--S.  Two  E--.--S. 

Ice.  lee. 

•").  li. 

Fi^li,      I'J^lit        Ounces  lUlieooked.            Fisli.    l-'ive  (  Minces  i  I'ncookcd.  l-'rc>ii 

Fivsli  Fisln.  Fisln. 

Bread.  Twelve  Ounces  I'.read,  Twelve   Ounces. 

P.  >1at<  "•-,  Six  <  )i  a  ices.  I 'ot  a  toes,   Fmir  (  liinces. 

M  ilk.  Two  Pints.  Milk.  T\vo  Pints  and  Hall'. 

Milk  I'liddin--.  Milk  I'uddinu'. 
Tea.  IlairOunce,  oi'( 'ocoa,  J  Ounce.          Butiei'.     One    Ounce    and    Half,  or 

Sll^a  I1.    (Ill'1    (  (mice.  Tl'i  ';|c  'le. 

Bu1  !'T.  One  Ounce  and  Hal!'.                          One  K^L;. 
On.'  !'._ 


L'"^  MANL'AL    OF    I  )1  KTF.TH  S. 

AITI.TS.  ( 'iiihDKKN  (lender  Ten   )\'<ir>t  o/\  !;/<•). 

7  S, 

Meat,     Six     Ounces     (Cooked,     and  Meat.    Three   Ounces  (( 'ooked.  and 

wit  liout  Hone*,  wit  liout    Hone). 

Potatoe-,  Fiulit  Ounces.  Potatoes.  Ki.u'lit  Ounces. 

Hivad.  Twelve   ()iince>.  Hfead.  Twelve   Ounces. 

Milk,  ( )ne  Pint.  Milk.  Two  Pints  and  Half. 

Two  KU---S.  One  F<ir. 

Pudding.  I'uddiiit;'. 

Tea,  Half  Ounce,  orl'ot'oa.  J  Ounce.  liuller.    One    Ounce    and    Half,    or 

Siiu'af,  (  )ne  Ounce.  Treacle. 
Hutter.    (>ne    (Jmice    and    llalf,    or 

Treacle. 

('I se,  (  )ne  Ounce. 

!».  10. 

l-'jsli.     Ki^-lii     Ounc'es     (Uncooked,         Fish,  Five  Ounces  (Uncooked,  Fresh 

Fresh  Fi-h  .  Fisln. 

Brend.  Twi-lve  (  )nnces.  ]'>read.  Twelve  Ounces. 

Potatoes.  Six  Ounces.  Potatoes.  Four  Ounces. 

Milk.  Two  Pints.  Milk.  Two  Pints  and  Half. 

Milk  Pudding.  Butter.  One  Ounce. 

Tea.  Half  Ounce.  Coffee  or  Cocoa,         Two  E-'-'s. 

;.  <  >unce. 

Su^-a  r.  (  )ne    ()u  nee. 
F.utter.  (  )ne  Ounce  and  Half. 
Tw,,  i;-u>. 

11.  10. 

Fish.       Four     Oiuiees     i  Uncooked,         ^leat.    Four    Ounces    (Cooked,    and 

Fre-h   Fi-ln.  without   Uone'i. 

Meat.    I-j-'lii    Ounces    (Cooked,   and          Potatoes,   Four  Ounces. 

without    Hone  i.  Hread.  Twelve  Ounces. 

I'otatoe-.  Ki.-'lit  Ounces.  Tuo  Ivu'.u's. 

Hivail,  Twelve  Ounces.  Milk.  Two  1'ints  and   Half. 

Milk.  ( >ue  1'int .  Piiddinu-. 

Puddin.u-.  l^utter,  Unc  Ounce  and  Half. 

Tea,  I  lalf   Ounce,  (  'oll'ee   or   (  'o<  ( >a. 

,'  <  )unce. 

Suu'ar.  ( (in-  <  )uuce. 
P.utter.  I  )ne  (  (mice  ;md  Half. 
Two  K-.u-s. 

1:5. 
Meat,     Six     Ounces    « '..oked.     and 

\\llllollt      PHI  lie '. 
Potatoes.    Ki'^ht    I  )llllces. 

P.read.  Twelve  (  Minces. 
Milk,  <  hit;  Pint. 


Ann.Ts. 
Two  Kirirs. 

I  '  1  1  1  i  1  1  1  1  1  u\ 

Tea.    Half  Ounce.  ('oilVo  or  <  'ocoa. 

(  Illllrr. 

Si  IL;-;I  r.    (  In,'    (  Illllrr. 
I  '.Ml  Iff.    Tw<  >   (  Illlirc-,.   or  Treacle. 

(  'li.  •.•>.'.  <  )n.>  (  Mince. 
I  !,  •,'!'.     (  lin-     1  'in!      a     ila  v.     i  ir    I  J.-.-r 
Mone     1    -  a  \v.vk. 


I!'  if  T<  ii,—  1  lli.  of  l.'an  MI.  Ml   \viliioui   I  ion  i*  lo  the  I'ini  . 

Sli'i,,///  Hi,'/'  Ti'n.—'2  Hi-.  .  •!'  Iran  in.  Ml   without    hone  to  the  I'int. 

Clu'i-l.-i-ii   /.'/•"//,.--(  lin-  <  'hi<  -k.  -li   lo«  -aril   I'int. 

<  iiir  Fo\\  I.  •_'  lli-.  I'or  Three  I'.-r-ons. 

Mill/mi.    -\.<-^  an.  I  ShoiiUer  (loin  ami  hi'st  .-ml  ol'  n«'ck,  sjn'cial  order). 

I!'  i  l'.      Sail   Si  I  N'.'i'.-i.l.'   lotlii'r   |.iinl^.  S|n'i'i;i|  .ml.'!'1. 

/,'//•.  1'ntliliutj.  -()n,.(  inn,-,'  Kir,-,  guartfi'  I'int  Milk.  Hail'  Oiim-f  Siiu'ar, 
(  .....  l-lu'L;-  for  Thrrr  IMulilillii's. 

>'(/,/(  i  it>uartrr  i'ini  Miiis.  1  (iiuirr  Sa.u'o,  Ounce  Su-_ar.  (  )iir  !•;--•  f,,i- 
Till',-,-  1  'ii.i.lnij.-.. 

<  'iisldi;!.  T\\  ,i   KUL:-.    llalll'inl    Milk.    1  lai  I'  (  luiir,-  Su-ar. 

/i/-<iiil  /'»•/<////;/.—  :,  .>/..  Su-'ai-,  I'li-.-a.l.  OIH-  F.iru  for  Four  I'u.lilinu-. 

When  the  poison  of  L;'"HI  \\-as  liiv-t  discovcrt'tl  to  '"•  an  arid,  a 
curious  in.-:tan<v  of  cureless  ami  slovenly  reasoning  was  funiisheil  to 
us.  'I'hat  su^ar  will  fri'iiieni  .  aiul  turn  into  an  arnl.  is  a  notorious 
fart.  'I'he  poison  of  ^-oiit  i>  an  acid.  '1'herel'ore  supir  iuu>t  \>c 
eschcweil.  'I'lns  illogical  conclusion,  however,  lii-nvt'il  a  certain  i'/'m- 
xi'iiililn  iti'i',  or  colouriliLr  of  reaiitv,  from  the  I'aet  that  with  some  ufotilv 
[lei-sons  siiLi'ai1  docs  turn  arid  in  the  stomach,  and  verv  ijiiicklx  too. 
lint  hecaiisc  sii'di  is  i!ie  case  with  certain  dvs|)e|itir  ^oiitv  person-  it 
is  not  wcil  to  lav  down  a  l>n>ad  rule  thereupon  appl  VHIL:'  to  ail  "joniv 
person-.  Asa  I'uie  it  mav  lie  aiHrnied  that  polity  |iersons  arc  not 
partial  to  sweet  food,  and  pa--  the  sweets  at  dinner  with  \»TV 
few  exceptions.  liu!  ail  the  same,  uric  arid  is  not  derived  from 
the  -aeeharine  elemenis  of  our  food.  The  old  school  who  :'•></ 
lad,-  sii'^ar  arc  ^ivin^-  wav  to  voiurjfer  men.  who  f,ii!o-»v  the 
eliemieo-nlivsiolo^ical  idianu'es  in  the  nitro'jreuised  element-  of  on:1 


In  the  prc-etil  eon  s  id  era  t  ion  I  he  u'outy  d\'-pcpt  ic  \\  ;  i  I  he  left  out . 
and  \\'  ill  I'eeoi  vo  a  ppropria  t  e  ni  ten  1 1<  ill  when  ind  ii;'e>t  ion  :s  dea  It  \\  ;  l  h 
in  a  laler  rhaplei'.  T"  imdude  him.  up  her.  would  render  ;h:-  chap- 
ter moi'e  ronipl  irat  ed  t  hall  i-  de-i  ra  1  de. 


MAM". XL   (>K    DIKTKTU'S 

Then  airain  some  persons  object  to  fat  for  u''>utv  people.  On 
\vli:it  their  objection  is  based  is  unknown  to  me.  For  mv  o\vn  part, 
niv  experience,  personal  and  other,  runs  mi  all  fours  \vith  Khsfein's 
directions  to  eat  fat.  (Mice  fat  has  passed  the  stomach,  all  trouble 
connected  with  it  is  apparent ly  over.  It  is  burned  readily,  nor  can 
tin-  objection  lie  in  the  tendency  of  fat  to  make  fat  in  the  bodv. 
For  we  have  every  reason  to  hold  that  fat  doc--  not  make  fat.  and 
that  the  fat  in  the  bodv  is  derived  from  the  surplusage  of  carbo- 
hvd  rates. 

The  food  element  which  furnishes  u  rie  acid  is.  then,  the  albumi- 
noid, ur  proteid  matters.  The  flesh  of  animals  H  i  he  main  source 
of  ^ont-poison.  It  is  not  possible  to  dogmatise  on  this  mailer:  but 
on  comparing  notes  with  a  number  of  ^-ood  observers  of  extensive 
experience.  |  lind  there  is  a  considerable  agreement  as  to  the  llesh 
of  the  larger  animals  beinu'  li'oiiiv.  The  white  meats,  as  chicken. 
do  not  seem  to  possess  the  same  strong  tendency  to  pass  into  uric 
acid  as  is  found  with  the  brown  meat-.  Caseiiic.  whether  in  its 
animal  or  vegetable  form,  seems  verv  free  from  this  teudeiiev  to 
uric  acid  formation.  Of  course  what  has  just  been  written  must  be 
taken  for  what  it  is  worth— neit her  for  more  nor  for  less.  An  im- 
pression mav  be  t'airlv  correct  ;n  the  main  even  if  it  cannot  lie 
represented  in  ti^ures.  A  diet  of  lentils,  if  ri^idlv  adhered  to.  is  a 
verv  \aiuable  matter  in  cases  of  conlinned  ^oiit.  Hut  this  fact  does 
not  rest  solely  upon  the  comparative  freedom  of  cascine  from  a  ten- 
dciiev  to  uric  acid  formation:  there  is  another  important  factor  at 
work.  Such  food  doc-  not  tempt  the  palate  to  excess;  and  thus 
the  livej-  ^ets  that  physiological  iv-i  —as  regards  iH  function  in  the 
metabolism  of  albuminoids  winch  is  so  important  in  the  recovery 
of  impaired  functional  capaeitv.  No  doubt,  maiiv  jjfourv  pi'rsons 
would  :_:'et  urea!  relief  from  their  tormentor  if  thev  could  anhere  to 
a  ilietarv  of  lentils:  but  then  human  endurance  fails  under  such  a 
gastronomic  trial.  The  late  Farl  of  I  >erbv,  it,  is  said,  once  had  some 
sherrv  sent  him.  which,  it  \va-  averted,  "would  not  make  v;oiit." 
lie  returned  i;  to  the  wine  merchant,  saving,  he  "  preferred  the 
irout."  So  it  is  with  a.  dietary  of  lentils,  The  llelircw  I'at  i-iarehs 
had  lloeks  ami  herds,  but  thev  lived  on  milk  and  lentils  and  I'arina- 
eeoiis  matter-^.  Indeed  !-aae  marked  an  important  familv  ceremony 
bv  tirst  partakiii1/ of  savoury  meal.  The  Zulus,  who  possess  a  most 
magnificent  phvsi<|tie.  live  on  milk  and  "  mealies."  or  cooked 
ma  i/.e. 

When  we  come  to  the  praet  ical  details  tif  a  ._:"<> uty  person's  dietary. 


wcmn-t     eep  te  carna 
well  in  \  iew. 

Soups  need  not  In-  forbidden,  as  tin-  amount  of  gelatine  ;-  no! 
verv  Li'ivat.  and  possibly  little  of  it  passes  mil  of  tin-  alimeiitarv 
canal.  \\hiie  soup-  made  with  eivani  are  L;'"<H|.  \  e^vtabie  .-.nip- 
are  excellent,  though  a  caution  may  lie  retpiiivd  alioiu  tho.-c  made 
from  legumes,  allieit  the  alluiliieii  is  easeine.  Fish  soups  art-  per- 
missible. All  soups  niav  lie  thickened  with  broken  bi.-cuit.  or 
contain  quantities  of  vegetable  mailer,  as  Julienne,  hoteh  \«>\  -h. 
Spring  soup,  and  u'l'eeii-pca  soup,  asparagus,  soup.  corn.  soup,  pea 
and  tomato,  turnip  and  potato  soups.  .Manv  persons  prefer  a  (juan- 
titv  of  onion,  and  others  celerv  in  ilieir  soup,  both  of  \vlndi  are  un- 
tihjeet  lonable  from  a  food  point  of  view. 

As  to  sauces  there  is  little  to  be. -aid.  l-';sli  forms  a  lar^'e  por- 
tion of  the  dietary  of  the  u'outv.  Ki-h  does  not  diil'er  fi-oiu  the  He-'n 
of  animals  in  chemical  constituent-  so  much  as  in  its  eompai'ativelv 
small  fond  value.  The  amount  of  actual  proteid  matter  in  li-h  is 
calculated  at  about  one  fourth  that  of  animal  t]e-h.  The  roii-c- 
(piciice  is.  a  comfortable,  sat  ist'v  in  £  meal  of  li-h  dues  not  overload  the 
liver  with  albuminoid  material,  as  would  be  the  rase  with  an  diual 
bulk  of  thelleshof  warm-blooded  animal.-.  The  ditTerenee  lies  in 
the  proportion  of  water,  which  is  very  larii'e  in  the  lle-h  of  li-h. 

.Manv  soups  are  made  from  lish.  |-'irsi  comes  the  attra<-ti\e 
erav-lish  soup,  after  which  follows  at  a  short  interval  (pistronomic) 
ovster-.-oup.  Lobster-soup  is  ",'ood.  A  white  soup  is  prepared 
from  anv  of  the  white  lishes  down  to  the  eonpT-ecl,  and  iiotaliiv 
the  haddock,  which  is  atlmiral)lv  adapted  io  tlu1  liodv  needs  as  Mril 
as  t  he  pa  late  of  the  ".-out  v. 

Then  there  are  cooked  tish.  the  whitiiiL;'.  the  hadiioek.  jhe  cod. 
the  turbo! .  the  brill.  1  he  skate,  t  lie  halibut,  the  -had.  I  he  john-dorv. 
the  L;'nrnel.  and  lesser  known  !i-h.  The  coarser  lidi  are  the  iini:. 
the  hake,  l  he  chub,  the  bream,  and  of  course  the  pike.  The  iroin. 
the  salmon  trout,  i  he  sewin  of  Somh  \\ale-.  the  lake  inml.  the 
salmon,  t  he  p,Tavlinu'.  and  t  he  white  lake  t  I'out  of  tlieSt.  La  \\n-ni-e 
are  all  excellent.  The  mackerel,  t  he  herrinu'.  the  pilchard.  :  he  eel 
are  t oo  rieh  m  oil  lor  nia  n  v  stomachs.  I  MI  I  ot  her\\  ise  are  perm;--  MI-. 
The.-e  li-h  mav  be  boiled,  or  baked  or  fried,  or  made  up  into  \\~\\ 
ba.lls.  tisll-cakes,  etc..  with  potato;  or  served  up  i"i  'li'ii'  a.  The 
smaller  llat  lishes.  the  sole,  the  llounder  and  the  plaice  are  --,,,,,!. 
but  if  fried  should  lie  prepared  with  care;  and  fc\\  thiii'j'-  thai  are 
eaten  are  more  oll'ensive  to  a  tetcliv  stomach  than  a  l>adh  frie.i  -o1..- 


}1. \.\TA1,    OK    IMKTK.TK'S. 

with  the  tihres  soaked  in  fat.  This  is  the  sourer  of  manv  ;in  attack 
of  aeute  inditrest  ion.  or  "even  :_:'out  at  the  stomach." 

The    shell    tishes.    a-   the  ovstcr,    the  rlaiu.    the    mu-sel    ami    the 

Scallop.    ;il'e    ail     excellent.          So     are     the     lohster.     the     eraV-tisll.     the 

shrimp,  the  prawn,  and  therrah.  Manv  othei1  shelled  tithes,  uiol- 
luses  ami  segmented  lishes.  are  eaten  in  dill'i-rent  part-  of  the  ^lolie; 
\vhlie  the  Chinese  |iri/.e  hl^hlv  the  sea-slui;'.  The  edihle  snail  has 
it  -  \  otarics.  !»ut  this  is  MI  >\  "a  ti-h. " 

'I'"  a  LTouty  mail  of  perfect  il  ivv.-t  ii  >n  a  loh-ter-salad  is  a  tvpii-al 
f 1.  It-  food-value  in  nutritive  material  i<  not  hiirh.  \vhile  of  its 

acceptability    hv   the    palate    It     IS    needless    to    speak".        i'Vh     111     lliailV 

forms  It-nils  ii-elf  ea-dv  to  eiirries:  ami  a  well-made  lish  currv  \vith 
pletit\  of  rice  is  au  excel  lent  ilish  for  a  ijou  t  v  individual. 

As  to  the  llc-li  df  animals,  the  Lrn-at  matt'-i1  to  ivmemher  is  that 
tliis  is  a  verv  concentrated  food,  rich  in  alhuininoids  and  therefore 
t"  he  eaten  sparinu'lv  as  regards  the  lean  at  leas!.  The  ijuestion 
o!'  dip'stiliilit v  is  nut  hein^  consitlered  here,  hut  t  he  dilTeivnt  fornis 
in  eciiimon  use  mav  he  arranged  prett\'  much  as  follows,  mutton, 
liecf.  lauih.  veal,  pork:  the  last  two  U-mijf  partaken  of  cautiouslv. 
Iiacdii  and  ham  seem  less  ohjeetionahle.  When  these  concentrated 
animal  fuods  are  eati'ii  thev  should  he  in  eompanv  with  a  fair  store 
of  fat,  and  a  liheral  supplvof  ve-'eta hies  of  all  kinds.  The  raliliit 
furni-hes  a  capital  chaii!_re.  e-peciallv  wlieti  conked  with  a  ouantitv 
of  fa:  i " >!'k  ( >r  haeon. 

The  same  mav  he  said  of  the  llesh  of  fowls  of  all  kinds,  those 
with  white  ilesh  heinnf  to  he  preferred  t«  those  with  hr<>\\n  meat  on 
their  holies.  Thu-  the  chicken  is  hetter  than  the  duck  or  ^foose. 

Til  I'K  c\    -eetn-    1 1  '    lie    111  ',<  !  \\'a  \'. 

T    •  ii.  a-  in  M-;nne.  t  !H-  same  mav  he  said  of  white  and  hrowii  meat . 
her    :     "•    u  fur  or  feathers.      A  little  ^ame   \«    tini.-h  otT  a  meal 
i-  ohj    -ti  d  i"  liv  the  imps!   I'iii-orous  I'ood-diseipliiiarmn. 
l'»    '  .•:  _ '  • . : .    '       '    '         I         i  if  hulk,  ami  1  it  t  le  m  u~t  he  taken. 

Tiieii  a-  in  -  •      II  T-  as  sweet hreads  and   niher  Clauds:    ti'ipe, 

1 1; IT'S  I'ei-l.  ,  d.  oi-  as  hrawn,  liver  and  haeon.  thev  are 

;  of  fat .  ami  t  he  small  ouan- 

t  it  V   of     lea          111  .        (  '  -    Hot     oiljeet  ionahle.         \  ('Ll'e- 

lahir-    form  a  '  •       di-rali!''    faetnr    in    the   dietarv  of   tip-   LT'OUIV. 

S'lllie    ohjcetloll      II  I      •       1 1      hi     III  I  isi  I  rooms  a  IK  1     <  >\  ll  e !'    f  U  1 1  H'i    he- 

o|       lhc|'      llieat-!lke      C(illl)l0-it  :n||.  \   e^'et  a  !  ile~      ci  ill  t  a  111  i  ll0.'     a 

'   t\     of    o\a    e    acid    disagree    with    manv    -joiitv    person-,    who 
avual  rl  in  ha  rli.  -oi'i'd.  I'  itna  toes,  asparagus  and  even 


broad  brans.  ISut  for  ordinarv  '_r<>utv  prr-on-  potatoes  in  aii  form-, 
carrot-;,  turnips,  parsnips,  beet,  broccoli.  IJrussels  sprouts,  eabbairr, 
spinarh.  endive,  li-ttuce.  bran-,  pra-,  harirots.  ^p-eii  corn,  ami  -u^ar 
corn.  kale,  leeks,  onion-,  -al.-ifv.  sea-kale,  samphirr.  lavrr.  celerv. 
vine  .-hoots,  euriiinbrr.  L^'lierk  in.  vegetable  marrow,  anil  oilier  !»--- 
LTeiierallv  used  vegetables,  arr  I'Xccllciit.  Manv  admit  of  brine;  \ari- 
ouslv  pivpared  so  as  to  furnish  that  desirable  matter,  v;/...  vari<-;v. 
Salads  should  lie  freeiv  eatell. 

Puddings  are  to  be  measured  by  the  amount  of  CLTLT-  :n  '-.'fii. 
The  (•",•";  is  rich  iii  albuminoids,  and  therefore  object  ionabir  to  ;i:r 
<n>utv.  All  miik  puddings  a-  rice,  tapioca,  sa^o.  semolina,  roru- 
llour.  malt-pn-parations.  and  other  farinaceous  matirr  should  '»• 
prepared  uith"Ut  CL^S.  oral  most  only  the  vlk  should  be  u-rd. 

Suet  dumplings  are  not  to  be  forbidden,  or  bread  and  butter 
pudding,  if  the  cook  \viil  make  it  without  ce.'i/s.  Ilu:  custard-  and 
omelettes.  sweet  or  savourv,  arr  to  be  shunned.  I'a-trv  is  not  j.rrr^- 
sanlv  to  In-  forbidden,  nor  vet  cakes,  if  ;he  ainounl  of  CU'LT  be  modrr- 
atc.  All  kind- of  creams  are  pi'rmissd»!e,  but  blanrmaii'_;"es.  -iiap"-. 
jellies,  lemon  sponge,  and  articles  of  food  containiiiL;'  much  ^c,aiine 
are  to  be  avodicd. 

l-'niit-  of  all  and  everv  kind,  raw  or  cooked,  arr  -uhable,  \vhat- 
ever  \ie\vs  mav  oii'-e  have  been  h<v!  about  -11'jar.  And  pirntv  of 
dessert  fruit  is  desii'able,  except  for  those  ^oiitv  pel-sons  \vit!i  \\hom 
siin'ar  disagrees  and  turn-  arid.  Indcrl  lemon  juice,  lime  ju;rr, 
oraiiLre-.  shai'idoeks,  and  the  like  sub-arid  fruit-,  are  at  [irrseiil  raihrr 
in  Millie  \vitli  persons  \vitii  a  ^'ouiv  or  rheumatic  tendency. 

Thru,  as  to  cheesr  ami  cheese  preparations.  Kveii  tiiou^-h  i-on- 
s;-t:nj'  of  i-aseine,  <dii'csc  in  larire  ijiiant  it  ics  H  not  parti'-u'.ariv 'ii-- 

sirable.      Sltch   dishes  as  toasted   cheese.  \Vel-ll    rarrbit.  rhrr-r   -ouill.'r. 

or  ramekins.  con<istin^  of  cheese  and  e^'s,  are  unde>irabir;  but 
macraroiii  rhrr-r  and  cheese  strap's  mav  be  eaten  in  moderation, 
l-'or  those  who  hankrr  after  thr  tlavour  of  i-ooked  clieese  a  rhrr-r 
pudding  i-  permissible.  l[oiuin\\  sa^'o.  or  rice  \\rll  boi'.rd  i 
and  mixed  \vitii  eliei-sc  liiirjv  LTrated,  mav  be  prt  into  th"  ..-..  -  ••< 
brown:  and  a  verv  Lfood  and  di^estilile  dish  is  so  furnir-hrd.  Nor 

should     lar^e    i|liailtities    of    llllcookeil     chre-r     be    ratrU.     ll!i'.e.-- 

rrram    cheese,    whirh    contains  onlv   a    small    proportion   ,,' 
l>i-cu:i-,  rrarkers  or   pulled    bread,  with    huttrr  and    a    '.  :<   "'' 
cher-r.  shouid    form  a  part    of    the    dinnt-r    of    ;!:••    ~j:><\\'\.       No   ••-  •• 
bu;    a    'j'lut  ton  \voii M    rat    too    hear! :  1  v  of  sii'di    chrr-r  a-    1  r  •  •!,'•; ..;•:. 
( iofj-.  iii/i  i,a.   N'riifc-hat  i-l.  ('amembi-rt  or  l!r  r. 


I'M  MAM   A  I,    OK    DIKTKTICS. 

The  small  pTeen  Swiss  cheeses  mixed  with  In-rlx  and  grated  on 
bread  and  1  nit  (IT  a  IT  unobjectionable.  Tin-  poorer  skim-milk  cheeses 
are  cigitra-indieated. 

As  to  milk  itself,  it  should  lie  taken  in  moderation,  unless  it  is 
taken  as  the  sole  food — a  regimen  which  agrees  witli  some  indi- 
viduals. 

As  to  des-ert.  nuts  and  fnuts,  fresh  or  dried,  are  permissible 
for  those  \vith  whom  tliev  a^ree. 

And  now  as  to  !>e\era°Ts.  Few  <routy  persons  ort  on  well  with 
malt  liquors.  Alesand  porters  brewed  after  1  in-  Knirlish  fashion  are 
so  niueh  ]  101  son  to  ^oiit  v  persons  of  thin  Hank.  I  in  Ik  v,  trout  v  persons 
can  on lv  indulge  t  heir  liking  for  sue h  malt  liquors  by  a  compensating 
a bst  inenre  from  the  llesh  of  animals.  No  polity  man  can  drink  malt 
and  eat  meat  at  the  same  time  without  paying  the  penalty  for  such  in- 
diseret  ion.  Beer  brewed  after  the  (Jerman  plan,  as  hiorr  beer,  does 
not  upset  the  liver  to  the  same  extent  as  Kn<rlish  ale;  and  manv 
LToutv  and  liilious  persons  ran  enjoy  a  draught  of  lau'er.  whether 
liaviere.  or  Milwaukie.  without  suil'erin^  therefrom.  In  mv  opinion, 
indeed,  the  lavrr  system  of  brewing  will  ultimately  prevail. — at  least 
unions  persons  who  have  to  be  careful  as  to  what  thev  eat  and  drink. 

Wines,  too.  dill'er  in  then-  ((Utilities.  All  u'ood  LiTnerou-  \vines 
must  be  Lriven  up.  Old  ['ort.  Madeira,  brown  Sherrv.  Tokav.  ( 'on- 
stantia.  Chateau  ^"(plem.  liuedias,  all  must  be  abandoiUMl.  1'ort. 
old  i;i  wood,  is  less  pernicious  than  old  bottled  port:  but  mo<t  "-oiitv 

1  1  ."• 

iiii'H  eschew  p'»n  wine  .-mine!'  or  later,  no  matter  ho\v  fond  of  it. 
< 'hamp:c_nie.  Moselle,  [[oek.aiid  liur^undv  are  scarcely  less  harm- 
ful, and  1  h:>.ve  seen  Li'oiit  simplv  bla/.e  out  in  a  few  hours  after 
Ma  ivobrunner  and  llii-ter. 

A  p'  ior.  t  Inn  wine,  as  t  he  poure-t  claret,  or  correspond  inu"  I  tai  ian. 
Spanish,  or  Au-tralian  wine  (I  do  not  know  the  wines  of  the  Western 
I  lemisplicre  and  therefore  cannot  speak  of  them),  is  all  the  vinous 
drink-  a  i-onlirmed  Lroutv  man  can  take  \\'\\\\  impunity.  lie  mav 
,-t  iii  pri'ie  h  in; -elf  on  hi  see  liar  but  it  is  \'«r  hi-  quests,  not  him -elf  ! 

A  little  spirit,  brandv  or  whiskey.  Seoieh.  lr;-h.  I'ourbon.  <  Md 
K've.  or  Monoii'jahela.  with  water,  i-  the  be-i  d;-ink  bevond  iloubt. 
Mineral  and  aeraled  waters  mav  be  taken  freely,  and  help  to  wa-h 
the  uric  ac'nl  out  of  i  he  1  issues. 

\\  hen  a  ^outv  maii's  palate  fa ;ls  him.  it  is  rather  a  fortunate  ac- 
So  |(>i!ur  a~  the  pleasures  of  I  he  table  are  [-"irarded  a-  amoni: 

01  hi     tllitl'_r-     of     lit'1'.    SO    loliLT     1-     tl    "     h    II    lenev    to     t'ol'lll      lll'ie     a«'id 

fo-ierei   and  favoured.      An  old  clep_:'vman  wa-  known  lo  sav    "  l'\'»; 


been  a  dvspept  ic  for  liftv  ve;irs.  Thank  (Jml  I'm'  \\  '.  "  The  cause 
of  hi-  [ii.)us  ^ratitiule  for  \vliat  most  people  regard  as  a  plague.  \vas 
the  fact  that  his  brothers  had  all  peri-died  from  LT"ii!  v  ail'cct  ions. 
while  his  dv-pep-ia  had  prevented  him  from  overworking  hi-  liver. 

\\"hen    the    liver  manifests  a    return    to  a  reptilian    condition,    it- 
owner    must    alter    his    dietetic   and    gastronomic    performances,      or 

sulTer  t  lie  conse'itlelices. 

Then-    is    no   nice  \vavof   liavin'j'  (lie    ^'"iit:    and.  what    is    wor-e. 
there  is  no  pleasant  \vav  of  avoiding  it. 


CHAPTER  XXATH. 

FOOD    IN     N  LfROSAL    A  FKLCTIONS. 

IN  dealing  with  all'ectious  of  the  nervous  system  there  is  one 
point  which  must  never  be  forgot  ten.  and  that  is  the  supreme  im- 
portance of  t'at.  For  IOUP;  the  <  lermans  ha\ e  recognised  this  Fact. 
<  speeia'dv  ill  reference  to  t  lie  t  real  nieiit  of  neuralgia  liv  eod-liver  oil. 
This  matter  of  the  relations  of  fat  to  the  nervous  system  receives 
an  i i ic i-cii lent  of  interest  from  t  lie  physiological  fact  t  hat  the  nervous 
svstein  is  rich  in  a  certain  phosphoriscd  t'at  kno\vn  as  Lecithin  with 
a  formula  ( '.  ,1 1 ,  ,\  I'<  >,  X  :>I  I.  O.  As  pointed  out  he  fore,  in  the  chap- 
ter dealing  witli  ana-mia.  there  are  onlv  t\vo  bodies  actually  made  or 
(a-  M.  l-'oster  puts  it )  "  ma  nu  fact  tired  "  within  the  animal  organism, 
and  which  are  not  found  in  the  vegetable  world. 

These  are  linked  with  the  function  of  the  Mood -corpuscles  and 
with  the  nervous  svstem.  two  matters  with  which  vegetable  life  has 
not  hini:  to  do.  The  one  is  Ila'ino^lobin.  which  enters  into  the  com- 
ju  is  it  ii  m  of  the  red  blood-corpuscles;  ;md  the  other  is  Lecithin,  "a 
conspicuous  component  "  of  the  brain  and  nerves.  .lust  as  under 
certain  circumstances  we  lind  some  persons  IICCOIUIULT  ana'iuic.  and 
the  red  blood-corpuscles  cither  arc  nut  made,  or  break  down,  or 
ma\'  be  somewhat  of  both:  so  m  others  we  lind  the  nervous  eiier^v 
waning.  lb',\  far  this  is  due  to  exhaitsti  m  of  the  .-tore  of  Lecithin 
is  a  matter  on  which  as  yet  we  can  only  speculate.  lint  the  hvpo- 
thesisthat  such  i-  the  ease  stands  in  a  curious  and  .-u^cstive  re- 
iationship  to  the  clinical  facts  thai  fat  and  phosphorus  are  so  ser- 
\iceable  in  the  treatment  o|  atonic  conihtions  of  the  cerebro-spinal 
.-  \'s  t  e  n  i . 

In  tip'  ini-v  struiru'lc  for  exi-'tcnce  of  the  pre-vnt  dav.  when,  as 
Sir.),  ('nchtoii  |')ro\\'!ic  da-  pointed  out.  "the  battle  of  life  is  no 
,  on;_rer  foil  L:'!  it  wit  1 1  1 1  lews  and  smew*  bii ;  !  >\-  the  brain."  t  lie  demands 
the  iierviius  svstem  are  <  ,ce-sive.  "  The  spirit  indeed 
is  willing  but  the  tlcsh  is  weak."  (  eiMainlv  the  spirit  is  -o  verv 
willing  t  hat  t  he  lle-h  must  trh  e  wav.  e\  en  wh^u  not  weak.  It  is  all 
very  well  for  (  Tilford  A  SI  but  t.  |-'.  U.S. .  to  charge  his  neurotic  pat  ienls 
witli  a  lack  of  endurance.  \\  liatever  powers  of  endurance  the  bodv 


FOOD    IN    NKIKOSAI,    A  FFKCTI*  )NS.  L'  1  , 

ma\  pos-ess  the  restless  tenant  would  exhau.-t  tliem.  The  sword 
will  weai'  out  the  scabbard  !  And  especially  is  tins  true  of  tho-e 
small  or  sliirhtly  built  persons  with  well-vaulted  foreheads  and  -mail 
viscera  the  Aral)  tvpeof  beings  of  the  neurosal  diathesis.  Their 
ivsile.-s  energy  brmirs  about,  sooner  or  later,  a  break-down.  'I  he 
assimilative  organs  cannot  supply  the  nutritn'e  pabulum  of  the 
nervous  system  in  sullicieut  ipiantilv.  the. -tori-  becomes  exhausted 
and  then  the  brain-power  irives  wav:  the  work  that  mice  could  be 
accomplished  with  ease  becomes  a  •rricvoiis  task,  and  a  little  later 
on  the  capacity  to  discharge  it  is  no  longer  present.  There  i-  a  dis- 
tinct brcflk-down ;  ami  the  j r  palient.  bereft  of  his  whilom  power. 

i- sent  awav  for  rest— to  do  nothing  but  recuperate.  Such  a  -tory 
is  sadlv  freo,ucni  at  the  present  time,  and  threatens  to  become  even 
more  common  in  the  future.  After  a  luiiir  rc-t  and  appropriate 

f i  the  brain  is  once  more  e<piai  t"  its  labours. 

In  such  a  case  the  individual  ha-  distinctly  drawn  a  bill  upon 
himself — borrowed  So  much  of  his  intellectual  capital:  and  th"  dav 
come-  when  that  bill  must  be  met:  after  which  follows  a  lonir  slow 
process  of  pavinir  back  into  the  liodv-liank  till  the  work  inn"  capita. 
is  once  more  sutlicieiit  for  competent  action.  There  has  been  a 
body-expenditure  in  excess  of  body-income,  and  so  the  reserve  body- 
capital  has  been  heavily  drawn  upon,  until  indeed  it  i<  too  small  for 
successful  enterpri-e.  ]5v  redm-mir  the  out  iromirs  to  the  minimum, 
and  raisiuir  the  incominirs  to  the  maximum,  a  new  balance  or  capi- 
tal is  regained.  It  i-  ju.-t.  like  a  man  who  exceeds  hi<  income;  he 
ire's  into  debt,  and  then  he  has  to  live  on  verv  little  until  he  has 
cleared  oil'  hi-  debt-. — and  then  he  can  <^>  on  airain.  When  the 
pabulum  of  the  brain  i.-  exhausted  a  lon^-  process  of  reetiperai  ion  j< 

lie  -(--itatcd. 

I  laving  secured  for  such  a  pat  ietit  t  he  requisite  re>l,  and  nervne 
tonic-,  the  next  (jiiestion  arises,  viz..  How  i-  he  to  lie  fed  /  Kxperi- 
ence  ha-  taiiirhi  us  the  fact,  before  physiological  cliemistr\  con  d  ;el! 
it-  ihe  wliv.  thai  fa  I  and  ti.-h  are  the  foods  specially  imiicated.  l-';-h 
i.-  rich  in  phosphorus.  A  pho-phorised  fat  has  to  lie  t'urni-hed  to 
the  m-noiis  system.  Hut  lo  supply  in  liberal  <pianiitie-  food 
taininir  phosphorus  and  fat.  is  not  necessarily  lo  re.-tore  to  the  im- 
paired assimilative  power-  the  capacity  to  build  un  lecithin  from  the 
raw  material-.  It  is  one  ihinir  for  the  contractor  \<,  collect  his 
material-  for  a  house:  there  are  the  ma-ons  and  brick, a\er-.  ine 
carpenters  and  plasterer-,  ihe  .-later-  and  ida/ler-  io  iui  Id  up  ihe 
ediliee  reiptired  for  it-  erection.  I;'  iln-e  i  '.-\\  ihcii  liie  work 


1_M^  MAM  AL    OK    1UKTKT1CS. 

of  const  rurt  ion  will  proceed  but  slowly,  no  matter  how  much  material 
is  to  hainl.  So  in  t  he  bodv.  1 1'  the  constructive  powers  are  but  feeble, 
then  time  is  essential  to  the  accumulation  of  a  sutlicieiiL  store  of 
lecithin  for  working  purposes.* 

There  are  the  capacities  of  the  assimilative  and  constructive 
powers  to  be  calculated  in  each  case.  When  they  are  fairly  vigorous 
comparatively  rapid  progress  is  possible:  when  thev  a  re  gravel  v  im- 
paired, and  still  more  when  the  individual  has  but  small  viscera,  the 
recuperative  process  is  and  must  be  a  slow  one.  The  digestibility 
of  the  food  must  not.  then,  be  lost  siu'ht  of  in  the  calculation. 
Small  meals  of  suitable  food  at  short  intervals  are  the  line  of  feed- 
ing to  lie  taken.  Then  lish  with  butter  should  form  a  conspicuous 
factor  in  the  dietarv.  .Milk  puddings  are  p>od.  As  a  beverage 
cream  with  sdt/.er  water,  or  other  aerated  water,  is  capital.  Cold 
coil'ee  with  cream  forms  an  excellent  combination.  ('reams  of  all 
kinds  are  u~ood.  Cod-liver  oil  and  oil-emulsions  mav  best  airree  with 
others. 

The  voik  of  an  ein^  i"  u  little  sherrv  would  make  a  little  change. 
Salads  with  oil  surest  themselves.  Stewed  fruit  and  cream  ouirlit 
to  f<  inn  a  staple  dish. 

\\  hen  we  consider  that  the  pabulum  of  the  nervous  system  is  a 
phosphorised  )•.,;_  u-(,  ,..,,,  eoniprehend  why  the  ]>lan  of  treat  HILT  cases 
of  cerebral  exhaustion  by  liberal  quantities  of  lean  meat  has  turned 
out  a  failure.  Albuminoids  do  not  supply  the  requisite  material  for 
the  intended  purpose:  while  in  their  metabolism  thev  furnish  matters 
which  mav  be  called  hepatic  mal-prodncts,  or  ''liver  stulTs,"  which 
possess  very  irritant  or  toxic  proper)  ics  as  regards  the  brain.  Con- 
sei|tientlya  highly  nitro^-eiiised  dietary  is  not  only  without  advan- 
tair1'.  but  actually  possesses  positive  drawbacks.  The  brain  is  not 

fed     thereby,    but    11!    i !  -   Wea  k  eiled    condition    is  a  11  lloVed   a  in  1   ye  Xei  1    by 
t  hese   "  li\  er-st  I!  tTs.  " 

Tliis  mailer  of  t  he  toxic  etTect  of  liver-stulTs  has.  another  aspect 
wh;<-h  is  well  worth  consideration.  An  American  patient  told  me 
that,  after  the  perusal  of  m\  work  on  "  Indigestion  and  Biliousness," 
hi  found  that  lii>  1"-'  hi-  bilious  headaches  bv  st  rikiu^  out  of  his 
dietarv  the  lli'-h  of  auiinals  except  lish.  lie  lives  on  a  milk  and 

naceou-  dietarv.  with  butler,  plus  the  li-h.  <  >n  this  restricted 
ri'LTini'-n  In1  ha-  e\ee  •  ih.  feeiinif  <mite  well.  I)ii t  anv  diver- 


FOOD  JN  NKi'KosAL  AFFKCTIUNS.  -!:» 

in'iuv  I'roni  this  (lu'Uirv  ln-in^s  \vitii  11  it- own  puni-hment.  I  >r.  A. 
I  lai<4\  our  ol'  the  casualty-physicians  at  St.  liarlhoiomew's  I  IOM  i;i;il, 
has  put  on  record  a  similar  experience  of  h;s  own.  arn\ed  at.  ipiite 

illdepelldentlv.  Loll^  n^'o.  when  attached  to  tin-  \\est  London 
Hospital,  a  patient  came  to  me  whose  expression  told  of  haliitnal 
HI  ll'enne;.  Shi'  was  torilH'llti'il  bv  severe  and  aliiio-i  rver-pre-vnt, 
hiiiou-  headache.  She  averred  she  eoniil  otnv  take  a  link  l<-a!i 
meat,  ilrv  bread  ainl  tea.  She  wa<  prevaile'i  upon  to  j^ivc  up  this 
ri'Li'iiiH'H.  not  \\'illioiit  coiisitleralile  d  MTn-ult  v.  and  trv  I'anna'-i'oiis 
matter  and  fat.  Much  to  her  surprise  she  soon  \va-  con-iderahlv 
lieMer.  'I'eii  veal's  later  she  iunie>!  up  a'-eideiitall v,  \vhfii  it  was 
found  that  the  iiuprnveineiil  had  heeii  maintained,  and  her  face  \vas 
free  from  the  '•pained"  look  it  hore  when  tii'-l  seen.  'I'he  theory 
and  the  clinical  facts  hanix  together  at  anv  I'ate.  if  a  more  positive 
expression  of  opinion  is  not  yet  warrantable. 

Some  per.-,  ,11  s.  ;ind  es  pec  Kill  v  women,  of  lii^hlv  developed  nervous 
svstem  and  small  digestive  power,  are  liaKie  to  reeiiriviit  storms  of 
neiiraln'ia,  speciiillv- facial  neuralgia.  Sometimes  ;t  is  fae;al  neurai^'.a 
(a-  ordinarilv  umlerstood)  at  other  time-  thei-e  is  intense  pain  in  the 
eve  ha  11  with  hem  i  era  n  la. 

\\dien  the  storm  is  Mowing  they  can  lie  ^ot  to  lake  medicine, 
hut  food  thev  cannot  lie  induced  to  take.  This  i<  a  .rival  mi-take. 
"Tain  is  the  prayer  of  a  nerve  for  healihv  hlood  "  said  lkoml>T_:: 
and  this  cxijiiisite  sentence  is  well  worth  hearing  in  mind.  The 
hionil  mr,-t  lie  e-ood  in  ipiaiitv  and  sutlieient  in  ipiantitv,  else  the 
nerve  ^'ivcs  out  its  'mart  ie u late  cry.  <  Mie  sulTerer  of  t  his  kind  came 
under  mv  notice  latdv.  Miik  was  ohjeeted  to  and  meat  infu>ions 
aioiie  wei'e  availahle.  lint  sueh  infusion-,  a-  pointei!  out  elsewhere. 
ha\e  (pract  icaii  v)  no  food-value.  Some  "  lactatcd  fooil  "  was  avaii- 
:ih|e,  and  l>v  the  addition  of  it  to  the  meat-infusions  the  strength 
\\a.-  maintained.  Not  onlv  did  the  svstem  derive  support  from  the 
food  to  hear  the  sull'erin--,  hiif  the  nerve  liein-'  better  fed  it  sooner 
ceased  its  wail.  Short  1  v  the  opport  un  it  v  olTer>  'd  :!  -e.  f  for  t  h  ;s  pa;  .ent 
to  pre-s  her  new  convictions  upon  a  friend  sull'eriULL'  ,n  i;ke  manuei-, 
and  w:lh  the  same  satisfactory  result.  \\dien  the  pain  is  on.  the 
sniTef'']-  can  onlv  ohject,  to  everv  propos:t  ion.  and  hc^s  to  'nc  ., •;': 

ill'il'.e.        Tile    patient,    however,   when   so   SUll'erini:'.    i-    not    a   en|i|!"-!e;:t 

jud'j'e  of  what  is  he.-t  to  In-  done,  and  mi;-;  lie  iirmi\  resisted.  llotii 
pa;. en;-  sulTerod  si-verelv  from  a  sudden  eold  -pe!i  of  weather.  Ti.e 
cold.  ;iir  of  tin-  niL!'ht.  caused  them  to  waken  in  ;i;e  morMiiv;  \\  ;ii 


L'L'n  MANL'AL   OF    D1KTKTICS. 

neuralgia.  Some  food  in  the  small  hours  of  the  morning  warded 
off  these  mornine  lace-aches  in  a  most  satisfactory  manner. 

(The  ell'ert  of  roid  air  in  t  lie  prod  net  ioi  l  of  t  liese  1  an  «-ai  'lies  seems 
as  follows:  Cold  causes  the  cutaneous  vessels  to  contract,  and  the 
cutaneous  nerve-tibrils  thus  liave  their  Mood  snpplv  cut  down,  with 
the  eonse(|uence  of  iieuraljjiti  in  the  starved  nerve.  1'roteciion 
apiinst  cold  is.  of  i-ourse.  one  preventive  matter;  u  hilc  a  snfliciciit 
suppiv  of  nutritive  Mood  ;s  another.  <>ur  ancestor.-  in  dranti'htv 
houses  had  bed-curtains  and  wore  meht-caps.  No  doubl  this  saved 
manva  face-ache.  Their  descendants,  wit  h  eiirtainless  beds. and  ie- 
norant  of  nielli-caps.  suil'er  i'or  their  advance  in  taste.  The  facial 
neuralgia  which  has  its  origin  in  a  cold  drive  is  a  similar  case  of 
ner\  e-starvat  ion. ) 

This  view  of  the  relation  of  food  to  neuralgia,  and  especiallv 
superficial  neuralgia,  is  well  worth  bearing  in  mind.  Such  nenral- 
i_r;a  lii'lon^s  to  persons  with  small  viscera,  and  who  can  only  take 
small  ijiiantities  of  food  at  once.  Thev  cannot  endnre  the  lonir  un- 
broken fa.-t  of  nieht.  and  should  have  somet  hinir  las;  thin«r  on  iret- 
tinir  into  bed.  and  also  something  Hrst  tiling'  in  the  morning  liefore 
commencing  to  <lress.  In  cold  weather,  beyond  this,  they  must  have 
some  food  in  the  small  hours  of  the  morning-  This  mav  consist  of 
m.lk  with  some  malted  preparation:  or  of  a  meal  infusion  with 
•on  i  predieested  food.  Tins  may  be  kept  warm  under  a  tea-cosev: 
or  on  the  hob.  if  the  lire  lie  kept  up.  or  a  .-pint  lamp  mav  be 
used. 

And.  by  attention  to  the  matter,  many  neura Uric  snll'e re rs  will  he 

e.  if  not  to  rsrape  their  plague  altogether,  -till  to  avert  much 
<>'  tin  ir  pain.  At  times  alcohol  in  >ome  form  mav  lie  indicated  as 
an  addition  to  the  food  ju-i  mentioned.  SoiuetMiie-  indeed  a  little 
alcohol  seems  necessirv  to  digestion  in  the  small  hours  of  the 
m or;  i  ir_r. 

{ >;•.  K me  Chamlicrs  de-eribes  a  eiirHMis  n enrol  ic  condit  ion.  linked 

\\  th   an    erroneoii-   dietarvthu  — "  Tliei-e  is  a  pc"iii;ar  form   of  ////- 

\inilrinxi.-i  \\lii'1]]  ari-e-   from  eating  too  little  vegetable-   and    too 

Ilieat.         It    i-   di-t  ili'_rui-heil     by    the    h  i '_d  I    ,-peeilic   -Tavilv  of    the 

( 1  .<)•.'.")    to    I  .n:;."i  |   ilepe    d<  ire-eiice    o!'    urea    almie 

i'ja  r.      Thi'i'e  i-  in  t  he  •   i-a-es  often  a  remarkable  lassitude, 

ippai'eiit   paraly.-i-   of    the  i  m!i-   -uddcnlv  occurring   after  e\er- 

i  o!i.      So  met  inie-  tin  i'e  i-  emaciiM  :on,      15ot  h  t  he-c  -vmptoms  n-ua  1 1  v 

•:•••'•;!'        •  ei  nite  t  he  morbid  state    to    m- 

rit  ion.  and  tn    i    •!•<•;    •     mori    and    more  t  he    i  iri  >i  n  MM  ion 


FOOD  IN  M-:ri;<»sAi.  AFKKCTIONS.  -_'-_M 

of  meat  iii  spite  of   the  aggravation   of  tin-  ailment.      A  rapid  ci;r<- 
allend-  tin'  ilimiimiioM  of  tin1  meat   meal-  In  one  ilailv.  and  tin-  ~ui> 
plvniL:  their  jilai-rs  \vitli  plrniv  of  porriilir«'  ainl  ^I'n'ii  vc^i-tali!i'-." 

Tliri-r  i-  aunt  her  |>ifcr  of  evidence,  that  \vhilf  the  I'rcliiiLr-  |'i'n- 
(liii'-'ii  liv  normal  digestion  are  ajjfrccahle  -lie!ire  the  praetiee  of 
charit v-dinners— wlicn  there  is  an  excess  of  albuminoids  in  the 
dietarv.  01-  the  liver  is  nneijiial  to  it-  \vork.  inal-prnihiets  are  formed 
which  possess  a  toxic  cll'ect  u[ion  the  nervous  >v>lem. 


CIIA  ITKU    XIX. 

Fool)    I'OK    (  URoMc    INVALIDS. 

A<  Tiiiirlit.  ''  ///•/"/•/.  lie  expected,  tin-  dieiarv  of  a  chronic  invalid 
dill'cr-  materiallv  from  that  of  persons  in  robust  health.  Yet  this 
obvious  matter  tines  nut  ahvavs  receive  the  attention  it  merit-,  and 
the  invalid  has  often  "  tu  take  what  is  u'"in,i:'."  and  \\  hidi  is  adapted 
to  the  !  K  ill  v- need>  •  >f  t  he  rest  uf  t  hf  fam  d  v.  Of  course  this  due.-  nut 
occur  in  thought  Inl  families:  lnit  is  apt  to  he  tin-  east-  where  one 
meinlier  uf  a  ruhnst  familv  returns  to  the  family  jjroup  in  hruken 
health.  It  is  all  vt-rv  well  fur  a  familv  tu  enjoy  unbroken  health; 
luit  lack  uf  fainiliarit  v  with  illness  carries  with  it  certain  draw- 
back-; and  of  tliese.  ignorance  of  what  an  invalid  requires,  is  one. 
There  is  no  intention  to  neglect  the  sick  ineniher.  or  disregard  his 
or  her  rei|iiireinent s:  it  is  simplv  a  case  of  want  of  knowledge. 
\\hei-eas.  uii  the  (ither  liaiid.  in  families  where  illness  is  nut  un- 
knuwn.  an  acquaintance  with  the  want-  of  sick  persons  is  fuiind. 
This  is.  in  the  hmir  of  need,  the  silver  liniMu'  l><  the  dark  cloud  of 
iilnc--.  I-'ew  phv.-icians  ln-t  have  had  the  above  facts  forced  upon 
'  attenl  on  fi-oin  nine  tu  time.  ('alleil  to  a  sick  person,  in  one 
v  to  lend  t  heir  services,  hut  the  will  i  HIT  vol- 
unteers are  an  1-dr  •  noli,  destitiite  of  anv  k  no\\'icd^e  of  \\~haL 
has  tu  lie  dune,  and  how  .t  has  tu  he  carried  <nit:  while  in  an- 
inily  the  phy.-ician  tinds  the  dilTereiit  inendicrs  readv  to 

fa        •  ;.     ::          In  of     In  f  place       ke  Wei  1-d  isci  p]  ined     soldiers.        IIow 

rcl:a-ed    their    knowledge    it     mav    In-    well    not    to    111- 
(|ture:    Suit   M   ;-  there  when  it   is  wanted-     and  that   is  something. 

With  the  chronic  imalid  the  position  is  sonic\\hat  dilTereiit. 
That  OIK  of  tin  female-  of  the  lions. -hold  which  has  the  kindest 
heart,  tip-  lic-t  head,  and  the  nm  •  •  •  ••  anils,  lake-  upon  her-elf 
t  he  task  of  tend  tr_T  t  he  sick  mem  1  n-r.  lint  no  a nion tit  of  willintf- 
ness  ca  n  com  pen  -ate  for  the  Jack  of  act  nal  in  format  ion. 

N'natTectiull      I''  at'd     "'T     the   i-Vll     elTcct-     of     lil'ead 

criitid'-  in  the  lied,  whi'di  -nun  iiecumr  hai'd.  irrittv  particles  readilv 
••   of    l.e.l   -ure~.       [Jead  \   and    a  ll'i         •        c  a-  she    is.   t  his  de- 
voted   woman    ha-    h>T    le.-son    to    learn,    and    prohaMv    learn-    :t      as 


!•'()(  >l>    !•'()!;    <   lli;<  INK      I  NY  \|.||>s. 

mii'di  utlit-r  knowledge  is  acquired  thr"ii'_:h  much  erri-;-  aiai  m.--- 
taki1:  hut  all  tin1  >amc  n  has  us  disadvantage-.  The  -eif-api»i:!:!ed 
nur-e  iiiu>t  pore  over  her  cookerv- book. and  ponder  n\.-r  w:,:i:  -he 
tiiiils  there.  If  some  ul  the  details  >erm  uncalled  for.  -oin>'  : 
untiecessarv,  she  will  do  well  i in!  to  exercise  her  ri;: lit  of  prisate  jnd'j- 
ineiii  and  make  modifications  of  IHT  o\vn.  h  is  ne\er  weli  ;o 
|iro|iheev  ahont  viands.  The  proof  of  ihe  pudding  i-  the  eating! 
And  it  is  not  well  to  assume  that  some  eooked  jirodiie!  will  he  tooih- 
.-onie.  It  mav  turn  out  far  otherwise.  Taste  and  trv.  I'aulV  ad\  i<-e 
1"  the  Thessalonians  to  "  Prove  all  things,  hold  fa.-t  that  wh>h  is 
Ll'ood."  applio  hei'e  Verv  l  "Tt  nieiil  i  v.  >i:e  should  make  a  private 
trial  of  eaeh  d..~ll  liefol'e  SiT\iuo-  j|  up  \,t  ;|lr  |)i\'aiid.  She  lliaV  lie 

pn/xled  what  dishes  to  select.  Il  will  lie  well  for  \\<>r  to  irive  he]- 
alUMitiop,  to  li^lit  rathej-  than  solid  food.  The  nnaiid  is  nut  emtai 
to  iinie'n  exertion  ai;d  therefore  does  no!  require  the  snh-lantiai 
repa-I  whieh  is  desirahle  for  the  hale  nieiidiers  of  the  fannlv.  and 
which  thev  enjov.  The  Itoilv-requiremeijl.-i  are  smaller.  (  >n  tin- 
other  hand  la<d<  of  exercise  leaves  the  appetite  impaired,  and  the 
y.c-\  for  food  is  not  so  kt  en.  Something  tempting  is  indicated  a 
small  liird  on  toast,  a  daintv  sandwich,  a  herring's  nuiiet.  or  a 
hit  of  cod's  me.  a  sweethl'ead  or  a  little  lish,  a  .-mad  qnantitv 
of  a  milk  puddinir*  or  a  little  stewed  fruit  and  cream,  or  a  i-ustard 
in  a  crlass.  something  small  in  aniouni  and  tempting1;  in  eharaeter. 

Very  often  the  cook  dislikes  the  trouble  of  these  iittie  ••odd- 
ments." Ill  which  case  it  is  better  to  trv  to  prepare  them  Mldepeil- 
dentlv  of  her  than  to  persist,  wit  h  her.  No  woman  vet  ever  made 
a  dish  palatable  \\hich  she  prepared  un  wi  11  invjlv.  A  cook  nin-t  n'ive 
her  mind  to  her  dish —  if  it  has  to  be  a  success. 

If  the  volunteer  experiences  a  dillicultv  in  her  selection  she  mav 
lind  considerable  help  in  a  little  bonk  "  Food  for  the  Invalid,  the 
(  'on  valescent.  the  I  )vspept  ic,  and  t  he  <  lout  v,"  jniblislieii  I  iv  Ma  MII  ;i- 
lan  and  ('o. .  containing'  some  three  hundred  ciilmarv  preparations 

selected    from    \arious  eookerv-books  and   compiled    bv    tile   write]-. 

She  must  learn,  too.  to  prepare  small  quantities  at  once.  |-e\\- 
I'oods  improve  bv  keeping,  and  fe\\  bear  \\'arm i m_;'  up  without  ,''-m^' 
much  of  t  heii-  toot  hsometiess.  Sometime-  the  famiiX  nieai  \\,!1  in- 
clude a  di.-h  of  \vhich  the  invalid  ma\'  fanev  a  lit  lie;  but  as  a  rule 
something  .-peeial  must  be  prepared.  The  invalid  canno;  h«\i.  ha\- 

HIL:'     bill     a     feeble    appetite,     or    even     beill^    dallilX.          I  1'ei ;  :  i  e  n  1  ,  \  .      no 

doubt.  I  he  in\alid  bears  much  quiet  Iv  \v;thoul  .-a\;n^  anvihinu' 
about  it.  I'tM'haps  !]<•  is  peevish.  Illne—  i.-a  trxiiiL:  mailer! 


L'l.'4  MANUAL    OK    DIKTKTK'S. 

As  the  amount  of  food  which  can  be  taken  at  once  is  small,  the 
invalid  must  not  be  restricted  to  the  family  meals,  but  have  little 
gastronomic  interludes.  A  cup  of  milk,  a  cup  of  beef-tea  with  some 
prepared  food  in  it.  a  little  custard,  the  volk  of  an  ejjftr  in  sherrv, 
or  some  chocolate,  or  possibly  even  some  sweets.  P>ut  here  we  have 
to  confront  a  ditlieultv.  vi/. :  How  far  do  such  minor  meals  destroy 
the  appetite  for  the  regular  meals?  This  must  i'orm  a  matter  for 
private  judgment  in  each  individual  ease. 

Sometimes  the  invalid  may  like  highly  seasoned  dishes,  but  as 
a  rule  plain  fare  with  condiments  in  moderation  is  preferred  bv  sick 
persons.  As  Sir  \\  m.  Roberts  has  pointed  out,  the  taste  for  savourv 
fond  i-  diminished  in  sickness,  and  simple  food,  unattractive  to  hale 
persons,  is  relished  bv  those  who  are  not  well. 

In  consequence  of  laek  of  exercise  there  is  always  a  tendency 
towards  sluim'ish  action  of  the  bowels:  and  this  can  usually  be  met 
bv  a  baked  apple,  a  1'ew  stewed  prunes,  or  liirs  occasionally.  Kspe- 
ciallv  is  this  necessarv  where  milk  forms  a  considerable  portion  of 
the  dietarv.  Meat-infusions  have  a  tendency  the  other  way.  Ac- 
cording to  the  state  of  the  bowels,  milk  or  meat  infusions  must  be 

resorted   to. 

Then  another  matter  is  the  avoidance  of  fat  by  invalids.  In  all 
illness  fat  is  objectionable  to  the  palate.  Whether  this  is  an  instinc- 
tive avoidance  of  an  article  of  food  which  cannot  be  digested  or  not, 
mav  not  be  atVinncd.  But  of  the  impairment  of  the  pancreatic 
function  in  acute  disturbances  there  is  much  proof.  This,  however, 
is  certain,  vi/. :  that  the  necessity  for  such  concentrated  fuel-food  as 
fat  is  much  diminished  in  the  case  of  invalids.  Confined  indoors 
to  a  uTeat  extent,  and  incapable  of  much  exertion,  there  is  not  the 
demand  for  livdro-carbons  which  is  normal  in  health. 

(of  course  this  statement  docs  not  applv  to  strumons  and 
phthisical  persons,  who  require  a  eertain  amount  of  fat  to  build  up 
healthy  tissue). 

Salted  and  dried  meats  arc  rarelv  relished  by  invalids  unless  it 
be  in  the  case  of  bacon  and  ham.  Tinned  or  canned  meats  must 
be  used  at  once,  else  they  turn  apiinst  them.  All  irreasy  meats  are 
disliked  and  drv  meat  preferred:  thus  a  chicken  is  in  request,  while 
a  succulent  duckl'mi:  is  rejected.  Boiled  or  baked  ti-h  is  preferred 
to  fried  fish,  as  a  rule.  An  evfir  is  a  favourite  food  with  invalids 
n-ually.  I'lain  boiled,  or  boiled  li^htlv.  and  turned  out  into  a  warm 
cup  containing  a  little  knob  of  butter  melted  with  some  pepper  and 
salt,  either  are  attractive.  Or  a  ILdit  boiled  ci:?,  turned  out  upon 


sonic  nice  mashed  potato  ;unl  mixed  therewith,  form-  ;i  dish  \(-r\ 
:iccc|it:ili!c  to  t  lie  palate  of  ;in  invalid. 

A-  t"  drinks  and  heverap's  it  is  impussihle  to  sav  anvt  him;:  -n 
much  de] lending  upon  t  he  likings  and  di~iikin^s  of  different  persi  •].-. 
and  so  iniicli  upon  the  actual  requirements  of  each  individual  ca-e. 

(Jreat  clcanlines-  and    neatness  in  the  serving  of    food  arc 

tial.    otherwise    the    appetite    flees  at    once.         \o    attractiveness   in    the 

viands  can  compensate  for  a  dirlv  plate  or  a  soiled  cloth. 
15 


riLAPTKR    XXX. 
!••()(  )1.)    IN    OIJKSITY. 

CONTKARY    to   \vli:it    llli^'llt     l»r    expected.    F;lt     eaten    as    food    is  not 

deposited  in  the  body  :is  l';it.  I'art  of  it  is  utilised  in  t  issue-forma- 
tion, while  the  rest  is  huriit.  The  fat  of  the  liodv  is  the  surplusage 
nt  carbo-hydrates  heyoiid  body-needs.  ()f  course  it  is  ohvious  that 
if  tlie  dietary  lie  rich  in  fat  fins  \viil  burn  to  maintain  the  bodv- 
lemperature.  and  thus  the  demand  upon  the  carbo-hydrates  con- 
sumed is  lessened,  and  the  more  remains  oyer  for  adipose  tissue. 

Fat  is  deposited  in  the  body  in  an  irregular  manner:  sometimes 
evenly  distributed,  at  other  times  certain  localities  are  selected. 
The  eye  lies  in  its  orbit  with  a  packing  of  fat  around  it.  The  salmon 
has  its  fat  in  its  tissues,  the  cod  locales  its  fat  in  its  liver.  Some 
persons  are  fat  all  over  like  a  fattened  animal:  \vliilc  other-  carry 
their  fat  in  a  thick  pad  over  the  wail  of  the  abdomen.  The  came!, 
the  dromedary  and  the  bnll'alo  have  a  lump  of  fat  on  the  back'. 

The  Kin::   of    Dahomev's  wives  are    fattened  on  rice  and    butter, 

pre\ious  to  i  he  nuptial  ceremony.      A  certain  plumpness  is  admired 

!i  some  animals;  and  a  re-er\e  store  ol   lat   is  often  very  convenient', 

carrying  with  it  a  certain   stay; nil'  power.      A  sleek,  well-fed  horse  is 

an  i  nst  a  nee  in  point . 

On  the  other  hand  fat  may  be  a  burden,  as  many  obese  persons 
kno\v  fiiji  well.  li  certainly  may  be  .-o  excessive  as  to  be  unsightly: 
and  fat  person- are  regarded  as  legitimate  objects  of  j'idieule  b\  the 
vulgar.  (  oiisefjiient  Iv,  many  and  divers  plan-  have  been  laid  down 
for  the  reduction  of  redundant  corpulence. 

Le\vi>  Cornaro.  who  \vas  a  corjuilent.  ifoiitv  man,  put  himself 
upon  a  spare  dietary,  vi/...  twelve  ounces  oi'  food,  mainlv  vegetables, 
and  fun;' ice1,  ounces  of  I  i'_dii  wine  dad\ :  a  i  id  on  t  his  li  veil  in  ^  iod 
health  for  over  half  a  century.  |-e\\  per.-oii-.  however,  could  undergo 
such  a  severe  re'j;  men.  A  not  her  <>hcse  ma  n  fed  la  r^el  v  11 1  ion  a  ppies. 
.in  which  he  reduced  himself  considerably.  The  LTi'eat  idea  in  the 
ditl'crent  plan-  uf  treatment  is  t  he  a\  uidancc  nf  carbo-h  vdrates  in 
the  food  >(j  far  as  i-  possible. 


There  are  two  plans  before  tin-  public  at  tin-  present  tini":  (!) 
JJantinunstn,  ami  ('-' )  Professor  Kb-tein's  plan. 

h  \viil  In-  well  in  take  ill'1  plan  advocated  by  Mr.  Planting  lir-;, 
because  it  must  lie  crit  ici.-ed  rat  her  than  ivrommriiil'''!.  lie  cut  <>:]' 
carbo-hfdnites;  no  sii^ar,  n«i  stan-h.  Su  far  so  p>od.  \\\\\  on  the 
other  hand  lie  allowed  unrc.-tricted  indulgence  in  albuminoids,  as 
the  tlesh  of  animals  for  instance.  Tin-  reduction  of  a  hitman  IKMUL: 
to  the  .-talus  of  a  earuu  onms  animal  has  Keen  attended  with  un- 
fortunate results.  Ail  aloni:  in  thi;  treatise  the  danger  of  an  e\ve-s 
of  a! buminoids  in  the  fond  has  Keen  steaddv  insisted  upon.  The 
dangers  involved  therein  ha\.'  been  planted  out.  e<pecia!lv  in  the 
chapters  on  "  liriirht's  I  lisease  "  and  on  "(iout."'  And  t  his  danger 
of  kidnev  injui'v  is  no  mvth  01-  imjii'.'iiKri'v  ri-k.  Not  lonir  a'j'11  a  verv 
illustrative  case  came  under  mv  notice.  A  man  of  sixtv,  \s~hose 
kidui'vs  were  pri  ilialilv  ii"t  ahovc  suspicion,  was  advised  to  reduce 

his  corpulence,  he  then    hciii",'  in  i;' 1  health  and    feeling    weil.       ll 

was  \\'eil  to  take  oil'  a  couple  of  stone-.  ln~  medir;il  man  .-aid.  ami  Mr. 
P>ant  in^'s  plan  of  reiiuction  was  recommended.  The  desired  re- 
duction was  accomplished  Imt  at  what  co-t  ?  No  susp'cion  of  anv 
impairment  of  the  kidiievs  seems  to  have  suir^ested  itseli'  to  any 
one,  to  put  lliciu  on  their  ^iiard:  and  the  untoward  result  was.  a 
condition  of  lithiasis  was  established,  and  in  a  few  month-  P.ri^ht'- 
disease  had  claimed  Us  victim.  \\  henever  anv  reduction  in  a  corpu- 
lent person  over  middle  ap1  is,  contemplated,  the  possible  condition 
of  the  kidiievs  should  never  1  ie  forgot  t  ei  i.  There  is  much  tva.-on 
to  iie!ie\e  that  main'  persons  ha\e  fallen  victims  to  their  desire  to 
reduce  their  corpulence,  and  the  adoption  of  IJantinu'ism  f»r  t'nat 
em!.  It  i-,  realiv.  a  very  dangerous  practice. 

Professor    I'llisteiu's    pian    is   free    from    the  dauber-    which    lurk 
around   Mr.    I5ant  m^'s    method.      The  ( lot  t  lU'j'eU    Professor,   who    ha- 
_i:'iven    much   attention    to.    and    has    written    a    small    bunk    on.    :..• 
subjeet.    sum-    up    as    follow.-:     "The    pei'iui-.-iou     to    eiijov    certa.:, 
succulent    thinii's.   alwavs    of    ctturse   in    moderation,   a-   for   in-lan^e 
sal  UK  in.    pale   de    i'oic    p'i'a-.  and    .-itch    l;ke   deiic;n-ics,   recondi,-- 
corpulent  gourmet    to   hi-  other  saeriiiees.      'I'lie-e  consist  in  ihe  c\ 
elusion  of  the  carbo-hvd rates.      Sifjar-.  sweets  of  nil   kinds,   potat^ 
in    everv  form.    I   forbid    uneondit  iouallv.      'I'he  ipiantitvof   lu-eaii    . 
limited    ,-it    most    to  :;  to  :'..',  ounce-   a    dav.  and    of    \  e^-ta  i'le-  I  ad"\v 
asparagus,    -pinach,    the    \arious    kind-    of    cabbage,    the    legumes. 

who-e  \aille  as  CHUN  e\'er-  of  album  ell.  a-  \  (Hi  ob.-el'\  e-.  ,  -  k  :,ou  ';  I  o 
few.  (If  lllea!  1  exclude  nolle,  and  t  he  fa!  in  [lie  ;!<•-:  !•'.••:; 


MAM'AL    Or    PIKTKTIr 


Ill 


to  he  avoided,  hut  on  the  contrary.  sought  after.  I  permit  bac 
fat.  fat  roast  pork  and  mutton,  kidnev  fat.  and.  when  no  other  fat 
is  at  hand.  I  recommend  marrow  to  lie  added  to  t  lie  soups.  1  allow 
the  sailees  ;i>  well  as  the  vegetables  to  lie  made  juiev.  as  did  Ilippoe- 
rale.-.  only  fop  h;<  sc.-am  oil  I  substitute  butter."  This  is  a  suin- 
niar\  oi'  Kb>;em's  creed.  which  is  a  distinct  impnn  ement  upon  the 
regimen  advocated  liv  Mr.  Banting.  Some  modilieat  ions.  however, 

mav   lie   SH'JU'e.-ted.  such   as    I'll  rt  he  I'  lie  velopme)  1  1    o!'    lish    111   t  lie  d  let  a  TV. 

F'i-h  of  all  kiipU,  fresli.  dried,  and  canned,  should  lie  largely  taken. 
Then  a  caution  abniit  the  amount  of  lean  meat  and  legumes  i>  desir- 
ahl  '.  as  heiii";  albuminoids  and  needed  in  small  iniantitv.  Salads  of 
various  kinds  are  ^ood.  The  lettuce,  the  endi\e  and  celery  iua\'  lie 
added  with  advantage  to  his  limited  list  of  vegetables.  The  onion, 
kale,  .-ea-ka!e.  turnip-tops,  do  not  contain  so  much  saccharine  matter 
as  to  exclude  them.  As  to  the  potato,  of  course  an  objection  lies 
airain-l  it  theoretically,  hut  when  t  he  stomach  has  to  he  ill  led  a  small 
<  ptant  it  v  of  potato  will  help  to  do  this  in  a  sat  is  factory  man  net-.  'I'  lie 
palate  iiiu-t  he  consulted,  and  so  must  the  stomach;  and  a  small 
quantity  of  forbidden  matter  mav  in  many  cases  he  desirable.  Onlv 
of  course  more  time  for  the  desired  reduction  is  then  essential. 

Piread,  biscuits,  crackers,  corn  cakes,  milk  pudding.-,  other  pud- 
dings. all  must  rutldesslv  ^o  if  the  reduction  has  to  he  successful. 

Malt  liquors  of  all  kind  must  lie  t'oivsu  urn,  and  a  li^lit  \\'ine  or 
spirils  and  water  alone  lie  indulged  in. 

As  much  e\c)-cise  as  ptjssihlc  should  also  lie  taken,  as  exertion 
counts  oil'  so  much  \'<  «  id. 

Hut    do    imt    Id    the    new  regimen  to  lie  [no  -evere,  or   so    riii'id  as 

to    atTect     the    Lreiieral     health.         If     ill     elTects   are     heillLT    experienced, 

some  i'e!a\at  ion  for  a  while  mav  he  advisable.  \\  here  ohesit  v  is  the 
outcome  of  indulgence  m  rich  food  in  unlimited  quant  it  ies,  comi  lined 

with  ^enerou-  drinks  and  halntual  la/.iness.  the  regimen  requisite 
for  its  I'eiluct  ion  will  be  lieiieiiciul  lyenerallv.  \\~.\\  where  a  person  is 
v  corpulent  and  vet  well  u;ih  it.  ;t  is  a  matte)-  for  deliberate 
thought  a-  to  bo\v  far  an  v  sudden  chan^'e  of  regimen  is  desirable. 
Some  faun  ies  are  norinallv  -imil  ji  '  :  others  ;)|-,.  |(.;in,  And  as  it 
is  impossible  to  fatten  the  latter,  so  it  m;i\  nut  be  wise  to  trv  to 
reduce  t  he  former. 

The  i  real  incut  of  nhe>it\  is  the  axoidanci'  of  carho-hvdrates; 
vh.ie  in  emaciation  carbo-h  vdraie.  n  theii-  mo-t  diu'est  ible  forms 
are  w'nat  is  required  to  -.-,.•  n  -.  -  ,  i  id  ties-  or  enibonpoint. 

'1  here    ;-.     however,     a    ci  rta  :         .'•  •  --     -ecu     in    females    al.    or 


about  pubert v,  ami  then  ajiain  ;it  tin-  menopause,  <>r  tin-  cha!c_:c 
of  life,  which  is  linked  with  aiKemia.  liirls  »r  women,  they  bee., me 
pa  HP  I.  the  blood  goes  thin,  ami  1'at  accumulates  upon  t  hem :  H  n-cia,  i  v 
t  lie  subcutaneous  1'at.  \\  it  h  u'iris  a  <  plant  it  v  of  iv< \  meat  ;-  a-  i-- -CM- 
tial  for  mre  as  are  chalybcates.  \\  ith  women  at  the  change  of  life. 
an  excess  of  albuminoids  mav  tell  upon  tin-  kidneys.  The  fatne.-s 
may  depend  and  docs  depend  evidently  in  .-oine  eases,  up'>n  the  .;.•- 
liciencv  of  red  blood-corpuscles,  leading  to  impaired  oxidation,  and 
from  that  apun  to  the  deposition  (as  fat)  of  the  itncon>uined  earbo- 
hydrates.  This  inipoverishiiient  of  the  blood  mav  be  due  to  the 
pressure  of  sonic  poison  in  the  blond  bi-cak  .IILT  do\\  n  the  I'l-d  bloo ',- 
corpuscles,  or  hindering  their  formation,  and  in  Mich  cases  the  re- 
moval of  the  toxic  clement  is  the  tir.-t  step  to  lie  taken:  after  which. 
the  cau.-e  bi-m0;  removed ,  all  ^ocs  \veii.  Such  a  case  cause  under 
mv  notice  sonic  nine  au'".  <o'tit  here  \\':i-  the  underlying  can-al 
factor:  and  t  he  cicai'in^  a\\  av  of  t  he  to\  ic  ap'iil  by  uric  acid  s<  >\\  cut  s 
\vas  in  one  case  followed,  and  (piicklv  too.  by  the  re-formal  ion  of 
red  blood-corpuscles,  and  a  reduction  in  tin-  adipose  ti-Mie.  I.nt 
the  reduction  of  the  fatty  tissue  in  ladies  at  the  change  of  life  - 
especially  if  >oiue  malnutrition  of  the  nni>ciilar  wail  of  the  heart  he 
a!s_o  present  — is  not  a  matter  to  be  lightly  undertaken,  and  reijir.i'es 
considerable  jm l^menl. 

\\  lien  a  person  is  naturally  stout  and  leads  a  rational  life,  taking 
exercise  and  eating  in  moderation,  any  ".Teat  reduction  in  hulk  is  a 
questionable  advantage.  Hut  where  obesity  is  the  outcome  of  glut- 
tony and  la/ine~- .  iheti  a  change  all  round  is  certainly  desiraiiie. 
lint  even  then  a  sudden  reduction  in  bulk  is  not  without  certain 
drawback-,  and  entails  an  exercise  of  the  judicial  powers. 

\Vhen  a  reduction  in  bulk  has  been  achieved,  persistence  in  the 
dietary  i-  neec.-sarv  in  order  to  prevent  increase  iu  weight:  and  a 
regulated  dietary — an  irk-uine  matter  to  say  the  least  ul'  it  — muM 
become  the  rule  of  l:l'c. 


('IIAPTKU    XXXI. 
TIIK    F<M)I>    IN    INDICKSTIOX. 

I'KOP,  \  IM.Y  none  of  the  topics  in  the  connect  inn  of  t'ooil  with  ill- 
ness is  more  interesting  lh;in  the  one  now  to  lie  considered.  It  \vill 
lie  neeessarv  t"  u'o  into  some  detail  in  the  matter,  as  "  indigestion  " 
ciivers  a  iar^e  Held. 

The  tirst  matter  in  this  consideration  is  the  physiology  of  divfe-- 
1,011.  \\  Inch  has  lieeii  spoken  of  he  fore.  I  tut  must  he  glanced  at  au'aiu. 
First  so  much  far;naeeoiis  matter  is  rendered  soluhle  bv  the  action 
of  the  saliva.  The  sicrliarine  elements  of  our  food  and  the  soluhle 
outcome-  of  starch  pass  readily  through  the  wall  of  the  alimentarv 
canal:  and  so  the  stomach  is  relieved  of  their  presence.  What 
starch  remains  untouched  l>v  the  saliva  passes  through  the  stomach 
(nnalTecteil  hv  gastric  action).  ;uid  tinds  in  the  intestines  the  pan- 
creatic solvent.  In  the  stomach  the  ail  mminoids  of  our  food  alone 
are  acted  upon.  That  is  the  second  section  of  the  digestive  uct. 
The  third  and  last  is  the  pancreatic  digestion,  where  starch,  albu- 
minoids and  fat  .all  are  dealt  \vit  h. 

( iastric  indices!  ion  then  mar  be  due  to 

1.    Too  much  undigested  March  in  the  stomach:   or 

'„'.    Albuminoids  too  hard  to  be  dissolved;   or 

:!.  I ;at  lloat  in--  about  in  t  he  stomach.  olTeiidin^'  it  and  interfering 
wit  hit-]  iroper  \\  ork. 

In  t  he.-e  cases  the  stomach  inav  be  eipial  to  its  dlitie-  if  the  diet- 
ary be  adjusted  properly. 

Then  there  is  indigestion  ba-vd  on  the  >;omach  having  more 
food  in  it,  {.i:,  a  larger  bulk  of  contents  than  n  can  deal  with.  Here 
smaller  i(iiant;t;e-  of  fooi';  must  be  taken  at  once. 

Finally  the  stomach  it-eif  ma\  lie  at  fault  and  be  uiieipial  to  its 
duties.  This  will  take  two  direct  ions. 

1  .      I)etie;,elleV    of    ^ISl  fie    JU  lee; 

'.'.      I  >efeet  JVC    JIIU-ell',;i  r    1IIO\  el)l'    '    '  . 

The  late  ])r.  Arthur  1. cared  held  that  pain  is  the  proof  of  the 
fir-t:  and  a  sense  of  distension  (with  flatulence)  the  evidence  of 
the  other.  In  manv  cases  the  two  arc  combined. 


These  last   catl.-es    df    indigestion  lnav  he  due   to   or^'a!^'    dd-a--. 

lilll       I'V      110      mcailS      IlcceSSarilv     SI).  l''llM''l;»li;tl      illeapaeltv      j          ;',- 

stomach  mav,  and  often  does.  e\i-t  \v!lli<Mit  oi"_ranie  eiianu'e.  I'  laav 
or  inav  not  he  followed  l.y  siruetural  IT  ^ross  alteration-:. 

\\  hen  tiic  stomach  is  at  I'aiiM  then  sunn-  nicd:e:nal  niea-nre-  are 
ralli'i]  fur.  whieh  (.•annul  he  con-idered  here.  l-'re<iuent  1 v  a  little 
arntieia!  pepsin  in  addition  1<>  the  amount  furni.-hed  hy  tin-  ineai>a- 
!'!i'  sTotnai'li  \\  ill  < -nali!  i-  t  he  la  hour!  i  it;  vise  us  to  vj  t  over  it  -•  d  ;!l;.-:i'.  •  v. 

<  M''en  t  lif  ad  i  i  it  i  "ii   of  rarinmat  i  vi'-:  and   cond  iment  s  to  t  he  t' i  will 

relieve  the  flatulence.  Mill,  tyrant  ::iu'  all  this,  and  imt  ati'-ni  ntiiiLT  'o 
underrate  its  ini|)ortanee,  the  main  mailvr  with  priinai'v  or  Lf:i>t  rii- 
indigestion  is  the  fond  laken  into  the  stoniaeh. 

In  the  lirst  j'iaec  n  must  lie  (if  siieh  eharai'ter  that  i;  run  he 
properly  disintegrated  hythe  teeth,  and  he  so  red  need  l»v  mast  ;ea- 
tion  as  to  In-  in  a  til  state  fur  the  stuinai  h  t"  ;iei  upon  it.  If  such 
dental  preparation  has  nut  u'one  on,  then  the  \\,<n\  reaelies  the  stuni- 
ai'h  in  an  unlit  condition:  and  conseqiienih"  that  visens  is  iiu-apahle 
of  deaiiii-'  with  it.  Defectlvt!  teeth,  the  lialiit  of  hoitin^  the  f.  .od 
uii'-hewei i.  and  unsnitahle  character  of  the  via;ul>.  are  the  main 
causes  of  thi-  fonn  of  indigestion.  Cei'tain  things,  as  pastrv.  win-re 
i'at  and  llonr  are  kneaded  tou'etlier  inlu  a  mass  not  ivadilv  d;-:n- 
te^rated:  cheese,  nut>.  hits  of  hard  meat  or  ^i-istle;  hard  pi«-ces  <if 
]>otato.  cahha^e  or  other  vep'tahle  matter:  all  ve\  the  stomach. 

In  the  case  of  Alexis  St.  Martin,  I  >r.  IJeanmoni  found  t  iiat  sn-ii 
ai'tieles  oU'eniled  the  stoiiuieii,  arresting  the  ilow  of  the  gastric  jn.ee. 
and  cati>iiiL;'  the  ImiiiLT  meinhraiie  of  the  stoniaeh  to  \,<-  drv  an-l  p-d. 
I-  roii  i  this  we  can  nnder-tand  the  notorious  clinical  faet  of  the  a'io\  e 
mentioned  artieles  provokinii'  indigestion  m  a  delicate,  sen-it  ivi-,  »r 
1'ceh.e  stoniaeh,  Persons  \vlio  can  eat  m o-i  articles  of  fo<id  \\.IM 
eonifoi't  tind  these  hid  iifest  ihle  ariieles  to  cati-e  them  sn  tTerinu'. 

('oll.-ei  jUelll  !v    tlli'V   should    he   SCl'tl  pll  lolisl  \    avoided. 

\\'here  ma sti eat  io ii  i-  defect  ive  owin^'  t"  the  lo--s  of  teet  h  or  t  :;eir 
(ieeaved  ciijiiiition.  the  :i;d  of  the  dentist  must  lie  imoked.  After 
!!:••  teeth  ha\e  been  put  ri'^'h;  and  are  m  working  o rile r  tin-  simnaeh 
is  no  longer  out  raii'i'd  hv  lumi>-  of  food  upon  which  it  can  c\ere;-e 
no  -oj\  -ill  aet  ;on. 

\\"he!-e  the  hahii  of  eating  quiekiv  olitain--.  and  I  lie  I'M,  .  Iiolted 
or  !la  pdrai;-om-d.  and  thus  the  >|om;i,-h  olTen.ied.a  more  rational 
met  i  11  >d  of  ea  l  ;  ]\'_'  \~  the  en  re  or  at  lea  -I  a  •_;'!•  ea  t  pa  ri  o;  : : . 

Mailer-  inliltrati'd  \\ilii  fai  are  provoeanH  of  i'a,nful  and  imper- 
fect dl"-e-'t;on.  A  hadlv  fried  -ule  :-  a  notorion-  o';,--,der  in  ;'.'- 


MA  NT  A  I,    OF    DIKTKTICS. 

respect.  If  the  cook  do  not  have  her  fat  properly  hot.  it  soaks 
through  the  fish,  and  tiie  muscular  fibres  so  becoming  coated  with 
oil  are  bcvond  the  reach  of  the  gastric  juice.  l-'attv  meat,  as  the 
ilesh  of  the  goose  and  duck,  are  avoided  by  dyspeptics.  Such  fat- 
swathed  muscular  matters  are  as  burdensome  to  the  stomach  as 
quant  ities  of  undigested  .-larch. 

These  are  gross  and  tangible  matters,  obvious  even  to  the  un- 
educated eve:  matters  which  merelv  require  to  be  pointed  out  in 
order  to  lie  comprehended.  Hut  bcvond  these  there  are  subtler 
matters,  such  as  t he  difference  betwixt  veal  and  chicken,  pork  and 
rabbit. 

Meat  hard  of  fibre  is  indigestible,  as  pork  and  veal:  then  beef; 
then  mutton  and  lamb.  Kven  parts  of  the  same  animal  varv.  A 
piece  of  hard  neck  of  mutton  is  much  less  digestible  than  the  loose 
fibre  of  the  meat:  on  the  sheep's  head.  A  veal  cutlet  contrasts  with 
a  sweetbread.  A  salmon  steak  contrasts  with  a  whiting:  though 
fish  arc  as  a  rule  more  digestible  than  the  flesh  of  mammals.  The 
fle-h  of  fowls  is  widdv  different,  as  a  succulent  duck  compared  to  a 
part  ridire.  (ianie  is  vcrv  digestible  with  its  short  fibre:  while  goose 
is  not  otilv  rich  and  greasy  but  its  fibres  an-  longer  and  coarser  than 
is  the  ease  with  game.  A  leg  of  a  chicken  is  less  digestible  than 
the  breast. 

Articles  that  are  flatulent  cause  indigestion,  and  consequently 
many  persons  of  feeble  digestion  have  to  eschew  the  legumes  as  the 
bean  and  the  pea.  1'eas  bear  an  evil  reputation:  and  especially  in 
the  drv  form.  Vegetables  as  a  class  are  regarded  a-  "windv." 
I'li'-ookcd  vegetables  are  to  be  avoided  bv  dvspcptics  Udt  onlv  on 
l his  account ,  but  because  uncooked  vegetable  matter  does  not  ivaddv 
undergo  di-iniegrat  ion. 

The  presence  of  starch  granules  in  considerable  amount  in  the 
,-'»maeh  i-  a  fertile  source  of  gastric  sulferinir.  This  is  an  aspect  of 
the  subject  .fa  i1  t  no  ]  i  1 1  le  consid  eivd  :  and  vet  it  is  a  matter  of  great 
importance.  The  gastric  juice  ha-  i  o  action  upon  starch  granules. 
This  is  quite  a  different  matter  from  mere  masses  of  farinaceous 
matter  like  pa-trv  or  [Me  crust.  The  disintegration  mav  be  perfect, 
or  fairlv  so.  still  the  starch  irranuic  i-;  a-  indigestible  in  the  stomach 
a-  so  iiianv  minute  particles  o!  •_  as-.  <  ommonlv.  however,  there 
;-  a  combination  of  causes  in  action,  a-  more  perfect  disintegration 
bv  ih"  teeth  would  iiecessarilv  briiiir  the  stai'di  granule  into  contact, 
with  the  saliva.  I'.ut  putt:nir  this  mailer  a-ide  for  the  moment, 
aia  en,  -iderinir  the  farinaceous  matter  .-imiilv  as  an  aggregation  of 


staivh    granule.-;    these    last,   it'    sutlieieiitlv    nuni'Tou-.   hamp'r    and 
oh-truct    the  action   of   the   >tomach.      'l'lie\ ah-orh   tin,'!:    they 
to  the  hurdeii  home   hv  the  stoniaeh  a.-  \«  its  mu-cular  iuo\«'ii,.  :<•-. 
'1'hev  incommode  it;    and  therefore  are  obstructive  and  unde-;rah!e. 

In  order  to  u'et  rid  of  an v  superabundance  of  -tare h  '/ran  11  !••-  t  he 
dyspeptic  ou^lit  to  take  the  farmaei-oii.-  articles  of  food  lir-;.  and 
adopt  the  rule  of  the  nurserv.  vix..  pudding  hefoiv  meat.  If  tip- 
niiik  pudding  he  taken  lir-t.  then  the  sah\a  can  act  upon  the  -tardi 
in  the  month,  in  the  gullet,  aiid  in  the  .-tomae'n  he  fore  it  hei-on.c- 
acid.  I!v  so  doiiiur  the  stardi  \vonid  he  rendered  -oliibie  land  -o 
e.-cape  through  the  wall  of  the  stomach),  and  wonid  '_:''•!  out  of  the 
\vav.  leaving  the  -tomach  free  to  deal  with  the  meat  which  coinc- 
after  it.  That  is  the  comiiion-sen-e  \H-\V  of  the  subject;  and  a  fol- 
lowing of  the  natura;  order  of  digestion.  Hut  cii.-tom  ha:1-  the 
adoption  of  siieh  measures.  The  dyspeptic  mii-t  rise  ahove  en-- 
tom.  That  i-  all  that  can  lie  said. 

Then  t  here  comes  t  he  <|iicstion  of  dealing  wit  h  I  he  March  granules 
previous  to  their  be  HILT  taken  into  the  mouth.  A-  ha-  heen  pointed 
out  liefore.  exposure  to  heat  not  only  cracks  the  -'arch  granule,  ''in 
render-  much  of  it  .-oluhie  as  dextrine.  \\  here  the  appiicat  ion  of 
heat  ;-  made  hv  the  maltinir  proee-s  there  is  a;-o  the  action  of  the 
diastase  upon  -tarch.  In  eases,  then,  where  the  presence  of  raw 
.-tardi  granules  oll'ends  the  stomach,  cereal  matter-  wlndi  have  nti- 
der^-one  a  preparatory  iliire.-tiye  coui'se  mu.-t  he  chosen.  I  here  are 
many  in  the  market;  hefore  IOIIL:'  thei-e  will  he  many  more.  In  the 
meantime  the  cook  can  put  her  farinaceous  mailer  in  the  oven  hv 
itself  for  .-onie  time  lie  fore  proccci  1  m<jf  to  heat  ;t  in  the  ordinary 
manner  for  a  milk  pudding.  Or  staivhv  matter.-  whadi  ha\e  un- 
dei'Li'one  some  pri ']  i  in  i  ii  a  r\' d  I  u'e.-t  lol  i  can  he  used  for  soups  or  hroih-. 
Of  oM.  hi'ead  well  hoiiei'i  and  put  through  a  >ii've  was  n.-eil  <•  th.-r 
a-  "  hread  jelly."  or  added  to  milk  or  soups.  P»v  so  iloin^".  aii'i  t  i!\- 
MIL:'  the-e  matter-  as  the  lii-st  course  at  dinner,  a  .-titVicieni  -upp,\  of 
LiTape-siiirar  woiiid  he  furnished  to  the  hodv  for  eomhii-t.on  pr.r- 
po-c-;  while  the  stomach  would  he  left  iineinliarra-.-ed  to  p:-o.-,-.  d 
\\  ;  t  h  n  -  o\\  n  \\  i  >r\\. 

li  is  ad  \'ei'\  well  to  point  out  ho\\  much  tronhle  aii'i  expi-n-e 
tin-  wiil  entail;  hu;  then  11  is  it na \oida hie  if  the  -\~-ti-m  -  to  ;,-.-i 
up  to  working  point.  The  d\pspept;e  ,-  an  nnfort  una;-'  n 

mativ  \vavs  to  he  sineereh    pit  iccl. 

\\'here  |  he  stomach  i-  ofVerided  hy  the  pre-eii-'i-  of  :'a\  a!,d  i-s- 
p"i-iahy  fat  en  ma--e.  or  in  the  laiiiruair"  <•''  the  :.  •::•-•  r^  'do' 


MAM'AL    OK    DIKTKTICS. 

lops."  such  source  of  otTence  must  he  avoided.  Very  often,  it'  the 
fat  lie  hidden  from  sitrht.  the  olijeetioil  to  it  is  lessened.  Where 
fat  ;s  not  well  tolerated  it  is  prudent  to  conceal  its  presence.  The 
stomach  if  left  unprejudiced  may  he  more  lenient  as  to  its  presence. 
It  may  he  necessarv  to  eschew  the  fat  of  animals  and  compensate  the 
want  of  this  hv  hntter.  Hutter  mixed  with  potatoes,  hutter  hidden 
in  milk  puddings.  Imtter  melted  withiish:  these  are  comparat  ivelv 
unoliject  ioiiahle.  \\'here  no  such  compromise  is  possible,  then  fat 
must  not  he  taken  till  the  work  of  the  stomach  is  over.  If  the  meal 
he  of  digest ihle  character,  in  from  one  and  a  half  to  t\vo  hours  the 
fat  mav  he  taken  as  cream  (with  maraschino  or  other  liqueur),  as 
cod-liver  oil.  or  as  an  oil  emulsion. 

What  each  individual  can  do.  or  must  do  in  order  to  come  to 
terms  with  a  tetdiv  stomach,  is  a  matter  of  experience  in  each  case: 
and  oiilv  to  lie  ascertained  hv  trial,  and  indeed  repeated  trials.  \ oi- 
ls the  stomach  a  1  \vnvs  the  same  as  to  tolerance.  What  can  he  en- 
dured at  onetime  is  intolerable  at  another.  Whenever  the  system 
has  heeii  taxed  or  upset  the  stomach  hecomes  intolerant.  Thus  \vhen 
the  system  is  wearied  the  stomach  is  hereft  of  miudi  of  its  capacity, 
and  food  ordinarily  well-horne  disagrees:  and  wliat.  is  more,  the  i:a-- 
trie  revolt  tends  to  hecome  chronic.  An  American  ladv-patient. 
with  dyspepsia,  traced  ]HT  woes  hack  definitely  to  a  certain  dinner  at 
(Jenoa.  After  a  Ion;:  day's  joui-nev  she  and  her  fellow  travellers 
arrived  at  the  hotel  just  as  the  tahle  d'hote  was  being  served.  They 
sat  do\vn  and  made  a  hearty  meal.  This  outrage  on  a  weakened 
stomach  in  her  ease  led  to  persisting  indigestion.  She  had  then 
sulTered  for  seven  months:  and  hy  the  greatest  consideration  had 
attempted  to  atone  for  the  original  outrage.  OlTonce  and  repen- 
tanee  are  neeossarv  with  an  injured  stomaeli — which  may  he  as  un- 
for^;\  inur  as  a  ( 'orsiean. 

Then  a'_rain  anv  mental  perturhation  may  make  itself  fell  either 
as  hv  io-s  of  appetite  or  hv  indigestion.  Had  news,  received  diirinLT 
or  shortly  after  a  meai.  substitutes  for  the  usual  eomfortahle  sensa- 
tions that  of  a  stone  in  the  stomach  as  the  food  lies  motionless  in  a 
palsied  viseus.  There  is  no  douht  that  the  di°;e-tive  powers  of  the 
A ii'_rlo-Sa xon  are  waning.  fMir  eai'ly  ancestor.-;  \vei-e  e(|iial  to  a  feast 
aft  «'r  a  hard  day's  mare  hint!"  or  ti^'ht  inir:  hut  not  so  their  nineteenth 
century  descendants,  who  when  their  energies  are  taxed  find  the 
stomach  impaired  in  digestive  eapai'ity.  I  >i-.  l'a\y  says  that  thi- 
fact  i-  recognised  hv  experienced  sportsmen. 

Then    a'j'ain    there    are    stoma'-hs    \vh:e!i    re-ent    the    presi-nee  of 


lluid-.  and.  contrarv  to  what    i-    usual    in    indigestion,  o;  '. 

agrees.       In  most  eases  of  dvspepsia  liquid  or  semi-iiqnid   fo.  ••;.  ••'.•,  '::••<• 

meat -infusions  or  milk  with  some  carho-hvdrate-.  sjjsea-ii 

the    -tomach.       I)ii t     in    the-e    exceptional    ca-e-    all     tlu;d    a-    far   ; 

]iossihie  has   to   lie  avoided.      If   th;s    he  niridl v  done   then    diLf''-':"n 

goes  on  normallv  and  without  discomfort. 

Ha\inir  thus  iv\  icwed  the  causes  of  indi'_rf.-t ion.  and  its  form-' 
and  varieties,  it  mav  he  well  to  consider  MS  ijuanr.tv  or  extent.  In 
some  cases  the  defect  is  so  slight,  that  if  the  more  notorious  of  m- 

dia'c-tihle    foods    lie   avoided    ail    is    Well.       Pa-lrV.     Ulieookeil     VCLTetahleS, 

nut.-,  arc  to  he  eschewed :  hut  not  hinir  more  under  ordmarv  eircu in- 
stances. (Mhcrs  airain  cannot  take  pork,  \'--a!.  or  cheese  without. 
su  iTerin-j'  for  their  indiscretion.  Then  come  those  \vho  mav  not  eat 
cold  heef.  or  a  hecf-stcak.  hut  who  can  inaiiair1'  mutton.  !•'••!•  all 
these,  ai'tilicial  pep-in  may  he  enough  I"  g'-l  them  over  their  ditli- 
cnlties.  1'ersons  who  are  no  worse  than  this  have  not  mudi  \<> 
complain  of;  thev  mav  he  put  to  inconvenience  HO\\-  and  then.  .  -•_ 
]iee;al  1  v  when  1  ra vei  1 : ir_:'. 

Then  come  those  more  irravelv  alllicted.  and  who  tva!!v  have  to 
he  \  cry  careful  al"Mit  t  heir  d'u-tarv.  They  mu-t  pa-s  ;  he  ve^-eta'  >]<•- 

as  a  rule,  take   verv  little  animal    f i    at    once  and  that   oniv  of   the 

most  d  iL:'c.-t  ihie  character.  Ki-h.  especiailv  white  ti-h.  and  honed 
or  haked  rather  than  fried:  chicken,  rahhit.  or  a  sweethread.  are 
theeh.ief  articles  of  food  with  them.  Thev  arc  rest ru'tcd  to  miik- 
ptiddings:  and  other  puddings  ha\e  to  he  foregone. 

\\;thsuch    persons   mailer-  an1   irrowinir  serious.      Thev  can    ire! 
on    I'airlv  well    at    home    with    a    cook    trained    to    meet    th.e.r   -o>  ,-;al 
needs;     \>\\\    ad    diiiinir  out   is  next    to    impossihlc,  who  '  hotel    ,,;'.• 
hunieii-onie   to   them.       It   is  we'll    for   them  ne\er   to    forget   to    have 
some  pcp-;n  near  a!   hand  \\dicn  eating;'  a  meal  a\\'av  from   liotiic. 

The  indi'_;'c-t  ion    of   males  rarelv  M-OCS  he\ond    this   except    ;n    the 

ca-e    ill    coll-ll  111  pt  l\  I'S,   or    pef-oliS    With    Some    all'ec'loll    o|     til'1    stomac'l, 

or   ,-ojne   acme   d  ist  urlianee   o!'    a    naturallv    irritahle   -tumach. 
with   females   a    further  limit   is  no!    uncommon,  and  then    the   <i:;cs 

tlon     of     a     Stltliclencv   of     food      to     SUStaill     life     hccnllleS     fea  !  1  \     !_'ra\e, 

(Mil\  liijiiid  and  semi-l hpiid  food  can  he  endun-d  h\  the  stotua'-n, 
and  that  too  in  hunted  quantities  at  once.  Smal,  ijuant.l.c-  ol 
meat -in  I'n.-iiins  conlaimnir  some  predii;"e-ted  .-'arch.  m:'i\  \\:'ii  or 
Without  some  malted  [ireparat i«>n,  a  haked  apn!e.  ..:•  the  •••  of 
some  .-;  e\\  cd  I'm  it  :  such  form  t  he  d  icta  r\ .  I '  -  no;  an  IM-V  matter 
to  "  r'nir  the  ehanires  "  when  the  clmicf  i-  -o  re-tr;ctc.i ;  and 


I':'1'  MANUAL   <>F    DIETETICS. 

1'ossiblv.  tlii'  appetite   is   small  and    the   palate   dainty.      'Tin-   hndy- 
i:iconie   is   neces-ariiv  sni;t'.i.  and    cannot    In-    raised.      Then    let    the 
Modv-cxpenditure  ]«-  reduced  to  the  minimum.      The   patient   must 
•_T"  l"  '"•';:  aii'i.  surrounded  !>y  bed-clothes  in  a  \vanu  room,  the  need 
:'<>r  fuel-food   is   i'roti^ht  d»wn  to   tin-    lowest   point:    while  perfect 
',;•.;;'•!  rcduc.-s  til'.-  demand   for  food  to  supply  force.      Ki^iil  economv 
,s  neces-arv  \\  it h  ~!,r;;:..  means:   aii'l  tins  has  a  w.iiiT  application  than 
:-:  i-'iMiinit;:  '  -    t.     1 1  ai'plics  to  t he  Imily  piivsii-aiiv  as  well 

a-  I"  M»-:al   un  '-  ".      A  -mail    ine..Mie  is  iiieimipatihh1  with 

!:iU'-h  fe.      I)'-'_rL:a:'v    is    the   alternative.      The   same    with 

th>'  !nt.i\    :    tii      >  :'_  'iiiir>  exceed  the  ineumin^s.  then  exhaustion  of 
t ::••  '  •  •  .    -  •  i-  :ne\  itaoie. 

Tlie  -inaii'-r  tii"  I'liik  of  the  foo.l  whieh  can  lie  taken  at  nnce  the 

-:.".•••    r  i-rval  mu-l  !"•  ht-twivt  nieais.       Kven  when  the  wonted 

fan-   '          •••   '     .      .   •  :;•    nnlv   in    limited    quantities   at   on^e.  a  small 

amoii!.:  of  :'--:    '•>•  ••'.'.•;•-;*   meals  is  usually  a  irood   praetiee.  esjiei-ially 

•    er.      \Vhen  the  patieiit  is  reduecd  to  the  condition  just 

<"•-•:•      •>!.    the   inti   •       -        '   ,'ixt    nieai.s   must    oe    mailc    verv   -hort. 

1'   >-;ii  /  it  -houM  not   e.\i-eed  two  hours  in  some  cases.      The  t'a-t  of 

.•     -       '        n  -.      Then.-  is  a   wcll-rceo;  '    lency  t»  a  iower- 

ti  e  fiody-eiier^ies  ''.  th"  -mall  hour-  of  t!i"  mnrniiiir.      Some 

•   •:   A.M..  is.    ino.-j    iic-ira!ile.      \Vith    man;    ladies   ,,;'   -mail 

••    i-apa'-itii'S    sii"h    nocturnal    nu-ai-  a<id    materially   to   their 

.   .  '.'.,•  •;  .  •/  r,f       '  •.      Such  per-ons  of  i-iiurse  arc  readilv 

:  .      •    •    •'  >' ;  •-  liv  ai  -••••'.•  ••  :   ,-.  :.;:•••".    ji  « >ne  of  t  hose 

ics  are  so  mad  as    to    ne'-e-:-!tate   their 

'•. •.:._•  ier  ;'    -'-'..  '  '        an  A-v  i  m;    •     :h  »u  -h  ifoud  ejl'cct-  that 

;  h"V   arc      .    rime  -an"  :'ii   to   !.»•  at   !;i  :'_•••.       i       'ontn  lilcd.  t  hey 

(•:•"  !"'._     I.-  ••'!.••   -<i  -  •  .  •••         •  •   •    ••  A-yium   restrain!   onet- 

luof".      A  :,' ;   t  h'T"  an-  p'-r-on-  who-i-  st  oma"hs  f"-"  ml  tie  these  eraxv 

',  Id  v-i  iepsia.  feijiiir- 

:  :._r  a  -'  r.  •'    :    .  ,      (  '  .-••.•'    improvement   is 

ma  :-•       /   .   tii"  \vo;  ;.•      -•-•  •  ;-  i-.-a.-i  cil;      n  •    drfore  lon^r  -oni"  upset 

'.••"--.':'-'••  •  .  \        I    Sll'-h    i~   til"    lli.S- 

.-,.;',,,.,,.;,•       ..         \  cs^iti     il      teaches     i-     t  he 

. —  P'I   t  !!"V  \\         ,o!     .  c.        . .  •  '"in"   watchful- 

•."--.  .  .          '  .         :    <•:,• ,  •!!•::.'_'.  :-    i  he    onlv    pi'otection 

l'i-o  •  •     of     .->,.•    'S   furiii-hes    more    pa:  i<-nts   t  han 

.    •          .   -  .     •  '  .     if     Hot      pi  i^cs-crii     (if 

•  :     '  •  •     •  iot"iit  ;a  1    hod  v- 


income  muM    never  enable  t  hem    t"   TO;!.      Th'-v  are   »'':••' 

te.d'jvnt    in    e\  eru  hnii:   'mi    their   food-reouireme:.;-.      K .  • 
thev  are  very  careful,  their  politeness   i>ft>-!i   ;':--'._- 
inducing  them  to  eat  something   which   ;he\-  k:,"\\    l:'"iii   <-\, •'•:'. 
disagrees  witli  them,  luit  which  llicv  do  ii"t  like  *»  '.•••'n~<\ 

Of    till-    class    of    person    I>r.     Pavy   speaks    a~    f«'l!"\\-      "\\i.'" 
chronic   impairment   <>f   power  exists.  a-   in   ordinarv   d •;-•.••••  -  a.  ' 
patient  must  lie  i_'ui'!ed  liy  what  i;  i-  found  liv  c\;i-i'ic!ii'c  \      .  a_r--c. 
\\'hilst  a  void  in--  that  \\  hidi  i-  known  to  !n-  nf  an  i  i  :•  i  :--.•-:  i'...-  ;. a  ::;•.•••. 
ainl    whatever,  through    ii'.iusynerasv.  n:av   happen    in    par:  i  ••;':!!•   i 
stances  to   up-ej  the  stomach,  th'- ina\iin   of   management  >iiou!.i  '>•• 
t"  keep  tlie  (iiei  a- closely  to  what    i-   natural  a~   the  eiivinnstan'-.'S 
df  the  ea-e  w ! ! i   permit.       I''i'i'i|iie!iri v.  ln-eaii-e  a    per-on  ;• 
from  livspepsia.  he  is  recommenun!  tn  lea\e  u;T   t!i:<  a:nl  tliat  article 

of  f i.  and  mav  per!iap<  i;i  the  c.iur-e  nf  time  !,,•  re  luce.!  in  ;akiii'_r 

•  •xcli!>.vely.  or  almost  exelu-iveiy.  liijuii]  uourisiime!:!.  S:ich  in 
it.-elf  i-  sntlicieiit  to  lower  the  aireadv  enfeehlcd  puwer  of  the  <;.'m- 
acli.  'I'he  oi'Li'ai!.  Lfettinir  no  einplovment.  lieciime-  \\eaker  and 
ueaker.  and  is  also  prejudiciallv  intluenced  !>y  the  dcfcctivc'iv  ':«\\r- 
i.-liei!  state  of  the  system.  The  aim  (if  the.phvsician  in  thc-cca-cs 
.-hould  lie  rather  to  raise  liy  appropriate  treatment  the  di-v-::\e 
capacitv  to  the  level  of  digest  inp:  li^ht  but  ordinary  food,  than  to 
reduce  the  fund  to  an  adjustment  with  a  low  standard  of  digestive 
power.  " 

This  aspect  of  the  matter  i~  here  well  put.  Instead  of  eui;:nu' 
otV  one  bv  one  the  diiTrrent  articles  of  diet,  it  wou'd  lie  !ietieri:i 
cverv  wav  t"  !»•  able  to  tell  the  unfortunate  dy-pcptic  of  some  ne\\ 

article   of   !' i  which  can    lie   taken  safei\.      \\'h;ie  inti-oduc;i,i;-  ;i,;.i 

the  stomach  the  food  requisite  and,   indispensable   for  the  bod\    need 
in   anv  po-sdile   shape,  the  aim  is   to   ra:-e   the  digestive  capac 
appropriate    medicinal    measures   as  well    as    suitable    food.      \\herc 
the  system   at    lar^e    is    badlv  noui'ished    the   stomach   >hare<    in    the 
general     enfecbletiient.       I'reii  i^oted    food,    mav    be    una\o;c,abie    to 
rai-i.1  the  general  tone;    not  to  relieve  the  stomach  of  ail  work.      T"0 
rea'lv  resort    t"    peptonised    foo^i-    mav  tvailv  «t;il    fnrllicr    loucf    tiic 
ea[iacity  of    the  stomach.      On  the  oilier  hand,  anv  iiidi-  :v;:ic,  n;a\ 
throw  the   ease  back  and  all    the    lal'onr  be  thrown   auav.  >    d  a   new 
start    be    necessitated.      ( 'onseqiirin  Iv.  thr   trcalmen:    oi  -:  mi 

is  not  a  matter  of  o|l:-hand  direction-;,  but  of  deli  :!  o\er 

each  ,-ase  with  il-  individual  reijuin-meiit  <.  T.HI  ''  '.iiieiiiix  'he 
livsitentie  leaves  c>!l'  otic  article  of  f.  >nd  at'ler  anoihcj-  :.  the  palate 


MAM' A  I,    OK    IHKTKTirs. 

loathes  the  t'c\v  remaining  articles  of  diet,  and  the  starving  civat  ure 
oft. -ii  fasts  sooner  than  eat  them.  The  hod  v  must  he  fed  untd  the 
diu'er-tive  capacity  is  regained,  if  possible.  That,  Itv  a  judicious  diet- 
arvaud  proper  inciliciual  measures  the  digestive  organs  can  lie  n- 
stored  to  a  fairiv  capa'ole  condition,  is  a  mailer  of  fact.  But  in  had 
oi1  continued  cases  the  loval  co-operation  of  the  patient  must  hack 
U|i  the  wise  counsel  nf  a  competent  physician:  anv  defect  in  either 
be  HILT  fatal  to  success.  \\  lien  dyspepsia  is  linked  with  clironic  con- 
si  ipai  ion--a  common  occurrenci  —  this  matter  must  he  pointed  out 
to  the  patient  elearlv  and  forcihlv.  Such  patients  rarely  possess  the 
perseverance  indispcnsahlc  to  success.  If  the  [laticnt  noes  persevere 
courageously  tiie  reward  comes.  \\  e  vvt  what  We  deserve  in  life  to 
a  \erv  "Teat  extent,  and  the  maxim  certainh  holds  v;ood  nf  per- 
>ons  of  weak  digest  i  ve  power. 

There  are  two  mat ters  dvspeptics  must  ever  attend  to.  (1).  never 
to  touch  meat  that  has  heen  twice  cooked,  though  this  liolds  less 
against  lish  than  other  meat:  and  ('.')  fat  which  is  rancid,  or  which 
has  heen  exposed  too  lon^  to  heat,  or  to  too  hi^h  a  temperature. 
(hie  American  patient  could  e;,t  cold  hutter  in  anv  quantity,  hut  a 
fried  whiting  was  an  outrage  to  his  stomach. 

\\  hen  a  dvspeptic  is  reckless  (as  was  in  all  probability  the  ease 
with  tin-  late  Tom  ('arlvle.  the  philosopher),  lie  endures  a  ".Teat  deal 
of  avoidable  sulTerinLT.  But  many  dyspeptics  arc  of  this  class,  and 
especially  intellectual  dyspeptics.  They  perpetually  commit  outrages 
on  their  digestive  organs,  and  sutTer  for  them,  hut  all  the  same 
they  hold  on  their  own  way.  Kxperience  'iocs  not  (cadi  them. 
They  are  very  unsatisfactory  patients. 

<>ilpTs  a^ain  cotiuuit  these  recurrent  outrages  no1,  from  \\-ilful- 
ne.-s  hut  I'mm  forget  fulness.  \\h:le  ihesuhject  is  iieinij  discussed 
in  the  [ihysieian'.-  -tud\  they  a:-e  alive  to  ail  that  is  said,  and  endorse 
it  all.  But  \\  lien  their  minds  are  occii  pied  hv  other  mat  1  ers  a  11  this 
-  forLTotteii.  and  the  indiscretion  committed;  and  it  is  only  when 
the  unpleasant  consequences  put  in  their  appearance  thai  they  he- 
conie  coiisi-ioiis  of  1  he;  r  foi'--et  I'u  1  ness. 

The  nio.-t  unfortunate  matter  is  that  one  such  act  of  forget  ful- 
ness ma  \'  u  tii  in  a  OIIILT  lahor  o|  careful  d  iciary.  and  t  hi'ow  the  pat  ii'iit 
hack  to  chmh  [he  painful  ascent.  It  is  the  -tone  of  Si.-vphus  mice 

llli  ife. 

1'iut  one  curious  well-recognised  fact  there  is  in  connection  with 
ind  _'  ~tion,  \'i/..  when  the  crav;iiLr  l'"i'  a.  certain  article  of  diet  is 
very  stroii;.!'.  even  if  it  1 f  a  mo-i  ohjeet  lonahle  nature  a-  regards 


dyspepsia  ijpncrally.  it  commonly  happen-  thai  ;;  doc-  ;;., 
linn-  and  when  it   is  safe  !'>  permit    tin1  _  'rat  ili'-at  ion    <>: 
is  a  mat  ter  vet  hidden  from  us. 

Mill,  ail    the  same,  modern  ehemico-phv.-io!o";ica'    km>\\., 

do';c    milch    to   cnalile    11-    In    help   tin-   il  V-pept  .!•    ill    il,-    troll'li. 

c.ailv  when  tlic  patient  is  resolute  almiit   Ix-niLT  reiie\ed. 

(,'uti/i/  /)f/x/irji.«it/.  AVliateVer  the  i  i  i  Hi,  -il  1 1  i>  •-'  1  ' )  lie  e!  i-<  .1 ;  : : ;  -  r-  •  ', 
a!ui  overcome  with  the  ordlliarv  dvspeptic.  ihev  ai'e  enliam-c.i  >.  •;],- 
ea-e  (>!'  t  he  p)U  t_V  I  lyspe  pt  ie.  Tile  re.l'ief  \vi:!  1'etllelll  I  ief  what  i-  -;!,-;. 

in  the  chapter  deaiiiii:  \vit  !i  ;j-"!i' .  a1- 1:1;  hepatie  ri'vi'simi  aiiii  'in- 
i'i  ii'iua!  .mi  of  uric  aeui.  \\iie;iiei-  mv  :i-".-l  lin-i.-;  its  wav  intn  the 
irusti'ie  secret  inn.  or  not.  is  a  inatter  ^in'oiiile'l  in  ilarkiie--.  (''-rtain 

it    is    that      the     U'ollt  V   (1  \  ,-pept  ,.•     i-     tl'oul'ieil      \\  ,  I  !l     ai'liiiiV.         I'Hi-     aei.i 

siiivents  are  ilist inet lv  iiniieateil.  aii>i  withniit  tiiein  mere  i;.e;i>i^'. 
however  eai'i't'iill  v  eaiTied  mil.  is  !i:;i  partiaiiv  sueee>sl'ii!.  Tin-re  .-. 

too,    ill     tllese     (h'SpeptieS    a     llceitlcd     telldelley     t,»     i'ui'lll      1'aMei'i     l'a :  t  V 

aeids  ill  the  stoiiiaeh  fro]  1 1  anv  fat  t  hat  ha-  iiad  [no  lutieii  nf  :  in-  i'n-r. 
( 'n:i-i-i(iieiit  iv  ail  fried  meats  are  to  !>•'  a\  <>.'if  !.  e\  >•!!  itn\\  :i  [n  ;i-:i. 
Their  lish  should  1"'  hoiled,  or  haketl.  and  u  hat  is  left.  e..id  .-ho'ii  i 
lie  served  up  as  lish  |iie.  which  mii-t  ii<>!  lie  iuo  IIIM^;  :u  the  o\i-n. 

Then  an'ai  n  t  he  v  til  id  sweets  IIHI  n  ad , ,  \  t  urn  ae.d  in  t  m-  .-ti>inae!i. 
and  e-peeiall\"  the  eaiie  .-u-'ar  addeii  hv  t:;''  conk  to  fruits.  ,\-  a 
1'iile  a  u'outv  per-on  is  not  a  "  s\vect  Lout  h."  ami  -\veets  are  a'ljnreil 
hvtheiu.  Still  many  would  like  to  take  .-tewd  Iruit,  if  thi- e«ii!d 
lif  iloiie  with  impunity.  As  much  luearhonate  <>\  pntash  as  v. .  . 
on  a  HiniiiiL:',  or  a  ijtiarter-hit  to  each  pnund  of  fruit  when  put  in:<i 
t!ie  o\fii  t'>  ste\\'.  \\'iil  neutralise  the  aeiditv,  and  lifiiiu'  1 1  ui  the  nat- 
ural sweetness  of  !  he  i.evulose  suirar  in  the  fru.i  which  is  ma-k' d 
li\  the  tVee  acid.  Sii'-li  st"Wcd  fru.t  \v.ii  no!  oniv  not  "ead.i\  ::;rn 
:ic;d.  lei!  it  provides  an  uric  acid  solvent  in  a  verv  palata'o.e  and  un- 
i '! iject  iona! lie  form.  Hv  usin^  canned  fru.i  in  winter  and  -IT:._' 
Mil  MI'  stewed  fruit  ca  n  l>e  had  all  the  \  ear  mu  mi.  <  >r  a  I  laketl  a  p;  • 

rail    lie   eaten    ill-lead. 

Milk  [imldin^s    made   without  eir^s   should  form   a    lar^'11    p" 
of  the  dielarv,  and  the.-e  should   not   lie  sweetened   I'V  cane  >UL''a:-  '>:;: 
li\  othe!'  sii'^ar,  as   milk  suL;'ar  or  he\  u,o-c.       An  adm:\iurc  ..;    ma.; 
with  farina  perhaps  ^ives  t  he  Ix'st  re-uit.     l-'ai\na--i'ou~  ma:  ti-r  \\  :i.  -h 

ha.-    pl'e\  loll-i  \'  I  iei  -n  e\  I  m-rd    to    ileat  ,    as    -I  :rc'ided    Ilia  l/.e.  cooki  •• !    i  I'  'Ill- 
ill  V.  Ill  all  ed   nee.  or  lirokell    liiscltlt .  etc. ,  ,-iioii   d    1  >e  .-;  in'ed    i,  1 1   U  "  h   an 
eijua;    ipiantitv  of   LTround    or   crushed    ma.!    in  a  puiidii'.LT    •   .4i;  :: 
tiver  this  should    lie    poured    milk   li"t  c:i"ii^:i   !•:;;    i:"'.    i""  !:••;   ' 


M  AM'Ah    OK    IHKTKTH'S. 


sipped.  Thi1  dish  should  lie  placed  when1  it  M'lll  not  <^et  cooler 
(iiiul  not  much  hotter)  t'di- ten  niiniites,  after  which  it  can  he  put 

lllto  i  lie  dVell  lollLJf  enough  to  hcci  uiie  Sl^li  t  1  \  .  Such  [>U<  1'  1 1  HIT  <  Iocs 
in  M  require  to  lie  kop;  in  l  lie  oven  t  ill  it  is  "  enouirh  "  -as  is  the  case 
with  puddings  inaile  with  farinaceous  niaiters  which  have  had  no 
previous  aerjua  in  (a  nee  with  heat  — for  t  he  materials  have  a  1  read  v  lieeii 
cooked.  Such  puddings  will  not  turn  sour  with  most  <iotitv  dyspep- 
tics, thouLi'h  the  opposite  uiav  he  the  case  with  a  small  proportion. 

Then  a  staple  article  of  the  dietarv  will  he  soups  of  all  kinds. 
thickened  with  hrokeii  biscuit,  malted  rice;  or  cooked  farinacca- as 
the  A.  I!.  ( '.  cereals,  the  farina  coda,  shredded  mai/o,  baked  hom- 
inv.  etc.  If  sa^o  or  tapioca  be  used,  either  should  be  placed  in  a 
d  i-h  in  the  oven  for  an  hour  or  two  hours,  care  hcmu,-  taken  t  hat  t  lie 
farinaceous  material  is  not  scorched.  Or  the  sa^'o,  rice,  or  tapioca 
should  be  well  boiled  ere  adding  them  to  the  soup.  liv  so  doin^ 
the  n-k  of  lining  the  stomach  with  quantities  of  insoluble  starch 
W'liild  be  avoided;  a  matter  which  has  been  discussed  in  the  earlv 
[tart  of  the  chapter. 

Farinaceous  matters- — supplying  the  essentially  necessary  <n';ipe 
su'_r;ir  to  the  bodv--must  forma  verv  laruv  portion  of  the  dietary 
with  iroutv  dyspeptics,  and  must  be  so  treated  as  to  ^rive  as  little 
trouble  to  the  digestive  organs  as  possible.  The  more  such  t'arina- 
ceous  matter  ha-  been  cx|)oscd  to  heat  the  better,  and  the  lessdi^es- 

t  ion    t  hey    I'eipl  1 1'e    Wit  hill    t  lie    bud  V. 

Soups  made  witii  cooked  farina,  boiled  and  baked  fish,  milk 
puddings  prepared  as  directed,  baked  apples,  and  fruit  stewed  with 
potash,  grapes,  bananas,  and  such  natural  fruit  as  agrees,  carefully 
masticated  so  as  not  to  oll'end  the  stomach  by  tangible  lumps,  must 
form  the  staple  dietary  of  I  he  'j-outv  ilvspeptic  when  the  stomacl) 
is  yerv  irritable.  \\"hen  a  careful  curative  course  has  led  to  a  better 
state  of  atl'airs  then  some  chicken,  rabbit,  tripe.  swcetl)read  and  like 
d  iLfest  i  hie  ma  ttei'-  may  be  cat  en.  \Vell-liiashed  potatoes  with  cream, 
or  butter  and  miik  warmed  tniM't  her.  put  duwn  before  the  fire  to 
hmwn  (better  than  hein^  put  into  the  oven),  in  order  that  heat  and 
tiM'i-tiire  mav  .-till  further  modify  the  starch  granule,  will  form  a 
desirable  change. 

Cold  fat  i-  less  apt  to  t'"i'iii  fatly  acids  than  warm  fa!:  and  bis- 
cuits t  he  plainer  the  better  and  butter  should  furm  a  considerable 
portion  of  ea"h  uieal.  Ail  sweet  bis'-uits  contain  i-ane  siiif.'ir.  aiul 
.-o  are  apt  to  turn  acid.  Tho-e  which  are  made  with  malt  are  less 
objectionable.  ('ream  with  stewed  fruit  is  al-o  a  suitable  fat. 


FOOD    IN    INDH.KSTIuN. 

As  to  beverages,  a  little  claret  or  wine  of  like  character.  u!;!i 
8oii  ic  alkali  ne  water,  (better  if  effervescing),  i  >r  per hap-  alone,  ma  v  be 
desirable.  Or  a  littU1  pure  s]iint  and  much  water  mav  in-  preferred. 
As  to  tea,  coll'ce.  ami  cocoa,  there  seems  little  objection  to  tiiem. 
unless  one  or  the  other  lie  found  aetuallv  to  ilisairi'ee.  'I'ln-  eai.i1- 
su^ar  aildeil  to  sweeten  them  is  the  cause  of  iniii'h  of  th*1  ari 
(.'iToneously  attributed  to  tlie  beverage  itself,  it  seems  to  me.  \\.\k 
with  eijiial  parts  of  some  mineral  water,  a-  seltzer,  it'  m;M  alkali  he 
ni-eded,  or  Vichy,  or  X'als.  if  mure  alkali  be  desirable,  forms  a  .-tiit- 
able  beverage. 

Like  all  dyspeptics  the  p;outv  dvspeptie  must  ufi\v  his  m;nd  to 
t!ie  trcatmeiil  of  his  own  case.  If  the  dietary  is  restricted  and  the 
reu'imcn  irksome,  t  he  sutVeivr  must  remember  that  he  is  the  person 
beiietited;  and  that  it  is  only  by  the  observance  of  strict  dietetic 
rules  that  relief  is  to  he  obtained.  The  power  to  help  is  limited  to 
the  patient's  determination  to  be  helped — a  matter  the  dyspeptic 
must  not  forget  or  overlook. 


CHAPTER  XXX  IT. 

T1IK    FOOD    IN    IJILlorsNKSS. 

1'uon  AISI.Y  tlii'  contents  of  this  chapter  will  excite  ktH'iiev  criti- 
cism than  any  other  in  this  book.  The  vic\v  taken  traverses  the 
ordinary  opinions  on  the  subject;  and  yet  an  increasing  experience 
hears  them  out.  Some  half  score  Years  a<_n>  a  consideration  of  the 
chemical  composition  of  the  bile  acids  led  me  to  reflect  upon  their 
derivation;  and  from  that  a^ain  to  raise  a  practical  issue,  viz.,  the 
proper  food  for  bilious  subjects. 

The  bile  acids  are  t\vo.  The  one  (Jlvcoeholic  acid  with  a 
formula  ('. ,,.!!,, ?s"Or;  the  other  Taurocholic  acid,  with  a  formula 
( '..,  1 1 1:  XSO,.  l)0th  contain  nitrogen:  ;md  one,  also,  some  sulphur. 
And  these  two  constituents  point  to  their  origin  in  the  albuminoid 
elements  of  our  food.  Then  comes  the  further  consideration  that 
persons  who  are  bilious  in  their  early  years  are  apt  to  become  ^outy 
in  middle  aLfe  and  advanced  life.  The  \vhol<>  subject  was  one  of 
deep  interest.  Instead  of  bile  benur  derived  from  starchy,  sugary, 
and  fat  ty  foods,  reputed  to  be  "  bilious,"  it  evident  lv  had  ot  her  asso- 
ciations.  The  dietary  of  lean  meat.  . Irv  bread  and  tea.  without 
Mii;ar  or  milk,  in  favour  with  the  bilious,  seemed  erroneous  in 
theory.  Hut  how  about  clinical  facts?  Th'1  proof  of  the  pudding 
is  the  eat  inir,  after  all.  One  confirmed  bilious  subject .  of  the  bil- 
ious d  iai  lies  is.  and  wear  HILT  a  !o->k  of  persistent  sulTcrinu'.  came  under 
mv  care  and  seemed  a  most  suitable  subject  foi1  experimentation. 
"\\  ith  some  didiciiltv  .-he  was  induced  to  ^ive  up  the  meat,  bread 
and  tea.  and  take  to  farinaceous  matters  and  milk  puddings,  and 
much  to  her  siirpn.-e  soon  felt  very  mu<-h  bettei-  for  the  change. 

II'1!'     case     has     heell     aiillded     to     before     III     the     chapter     Oil     F<)O(1     111 

A  ll'ect  ions  of  t  he  X  er  you. s  System,  and  -nice  writ  i  HIT  that  chapter  an 
opportunity  for  ^oin^  over  (lie  facts  (as  i  here  stated)  has  oil'ered  it- 
self jiud  contirms  them.  The  clinical  facts  fitted  in  with  the  theory 
so  completely  that  further  trials  were  made.  The  results  of  these 
further  trials  have  pointed  unmi.-takably  in  the  direction  that  much 
albuminoid  food  is  not  desirable  for  bihous  pei'.-on-.  despite  the  fact 
that  they  jind  such  food  sits  well  upon  the  stomach.  Such  food 


FOOD  IN  nil. lot  SNKSS.  i'|:', 

innv  be  agreeable  to  the  stomach,  hut  it  ccrtaiulv  taxes  th--  liver. 
The  analogy  used  in  "  Indigestion  and  biliousness  s  a-  follows: 
"A  vouii'4  man  mav  linil  favour  in  a  girl's  eves,  but  her  parent-  mav 
not  lie  satisfied  with  him.  Acceptable  enough  to  her,  tin-  MTV 
(|iia!ities  whicli  wei^rh  favourably  witli  her  mav  he  those  on  which 
her  father  specially  founds  his  objections.  That  food  wliieh  is 
acceptable  to  the  stomach  mav  be  the  verv  matter  which  disturbs 
the  liver."  Five  years'  further  experience  bears  out  what  wa-  writ- 
ten in  ISM,  when  the  book  appeared. 

The  function  of  the  bile  is,  so  far  as  we  know  it,  the  emul-ion- 
isiiiir  <>f  fat.  If  fat  be  abjured  t  here  can  exist  but  little  necessity 
for  bile.  If  a  disproportionate  amount  of  albuminoids  In-  eaten, 
the  material  for  excessive  bile  is  provided.  There  is  a  disturbance 
D{  balance  in  the  ecoiiomv.  If  fat  cannot  be  taken  the  excess  of 
albuminoids  can  be  avoided  at  lea.-t.  And  the  praefieal  result  is 
relief  to  the  bilious  symptoms.  In  the  present  stale  of  our  know- 
ledge it  is  impossible  to  lie  more  explicit.  Some  dav  it  mav  be 
feasible  to  u'ive  a  more  satisfactory  and  complete  explanation.  Our 
acquaintance  with  the  functions  and  operations  of  the  nver  is  re- 
cent, and  incomplete:  but  1  venture  to  think  the  rational  outcomes 
of  the  above  consideration  will  warrant  some  practical  conclusions. 

The  food  of  the  native  inhabitants  of  warm  count  ru-s  as  i:tk,.n 
fi»m  l^r.  1'avv  is  as  follows:  The  Mexicans  are  "accustomed  to 
uniform  nourishment  of  an  almost  eutirelv  vegetable  nat  uiv:  "  wh.ie 
the  inhabitants  of  New  ( 'aleilonia  "  subsist  eh ictlv  on  roots  and  li-h 
and  the  bark  of  a  tree;  "  while  in  Ilindostan:-  "  I-'rom  the  earliest 
period  the  most  general  food  in  Imlia  has  been  rice,  \vhieh  :  >r;ll 
the  mo-t  common  food  of  neariv  all  the  hottest  countries  of  A.-:a. 
I'uise.  root-  and  fruit,  are  also  larirelv  eaten."  (iliee  is  in  Lrreat  re- 
ijiiest.  In  (. 'ev'.on  they  ea!  "  rice  seasoned  wit  h  sa ! t .  and  a  t'e w  \eire- 
talilc-."  In  K;_rvpt  "  vegetables  form  the  principal  food  of  the  'ouvr 
orders."  In  the  Sahara  desert  "all  live  on  dates."  IJiiiter  and 
['aim  oil  are  also  m  demand  in  various  par;-  of  Africa. 

Tiie  Spaniard  has  his  bread  and  oil  and  onion-.  The  l:a.:an, 
mai/e  aipi  macaroni.  The  Turkish  hamas  ;<  a  viLforou-  man.  \et 
hisdictarv  is  almost  eiitirelv  vegetarian. 

"The  attention  of  Herodotus  was  called,  to  the  fad  that  :he 
I'er.-ians.  the  manliest  and  most  sport  ini,r  nat  ion  in  the  o.d  world, 
had  at  meal-  not  onl\  .-cverai  dishes,  but  sc\eral  course-;  of  ve^etabie 
food,  preceding  a  \'erv  moderate  allowance  ol  so.i.i  meal.  '  il\:n^' 
( 'hamliers.) 


244  MANUAL   OF    DIETETICS. 

Set  against  these  facts  the  other  fact  that  when  the  Anglo-Saxon 
persists  in  his  home-dietary  on  the  plains  of  Bengal  he  becomes  the 
subject  of  biliary  trouble,  and  not  infrequently  of  actual  disease  in 
the  liver.  Whereas  men  who  adopt  the  dietary  of  the  natives  suffer 
comparatively  little. 

Indeed  the  relations  of  hepatic  trouble  to  an  English  dietary  in 
tropical  countries  is  a  notorious  fact. 

Regard  being  paid  to  what  has  just  been  said,  the  great  object 
of  the  bilious,  like  the  gouty,  is  the  avoidance  of  albuminoid  arti- 
cles of  food,  or  the  taking  of  them  in  verv  moderate  quantities. 
How  many  persons,  who,  when  dining  out.  indulge  themselves  in 
meat  and  drink,  lind  that  a  calomel  pill  and  a  seidlitz  powder  en- 
able them  to  escape  sundry  unpleasant  after-consequences?  That 
fact  throws  some  light  upon  the  relations  of  the  food  taken  to  the 
function  of  the  liver.  Loss  of  appetite  follows  any  excess  in  food; 
and  what  does  that  tell  us?  When  the  liver  has  more  material 
brought  to  it  by  the  portal  vein  than  it  can  deal  with,  loss  of  appe- 
tite is  the  result:  and  by  a  period  of  abstinence  the  liver  works 
round,  and  all  goes  on  again  as  usual.  The  stomach  can  reject  its 
contents.  The  bowels  can  sweep  out  objectionable  matters.  The 
liver  can  do  neither.  If  not  protected  by  anorexia  the  liver  would 
have  rather  a  hard  time  of  it  with  persons  who  think  that  the  regu- 
lation four  square  meals  a  davuiva  part  of  the  Divine  Scheme. 
Loss  of  appetite  comes  to  its  rescue.  'The  bilious  disturbance  caused 
by  a  surfeit,  especially  with  children,  is  another  contribution  to  the 
subject.  The  liver  is  the  furnace  in  which  the  waste'  and  super- 
fluous albuminoids  are  burnt,  we  are  told  bv  physiologists.  When 
there  is  an  accumulation,  pyrexia  often  comes  and  helps  on  the  oxi- 
dation, or  in  other  words  '"  Nature  holds  a  bonfire."  P>y  such  means 
the  not  readily  oxidisable  nitrogenised  matters  are  burnt  up. 

1'ut  briefly,  with  bilious  persons  it  is  well  to  reduce  the  amount 
of  food  taken  to  the  body-needs,  or  as  near  this  as  can  be  attained. 
And  especially  is  the  moderation  to  be  practised  as  regards  those 
nitrogenised  elements  of  our  food  from  which,  obviously,  the  bile 
acids  are  derived. 

Bilious  persons.  th>'n.  should  avoid  the  solid  joint  at  meals. 
Joints,  chops,  and  steaks,  indeed  lean  meat  in  every  form,  must  be 
taken  in  verv  small  quantities,  if  at  all.  Fish,  as  a  less  concen- 
trated form  of  albuminoid  material,  is  to  be  preferred  to  flesh. 
Vegetables  should  be  larii'e'v  eat  n.  Fruits  do  not  disagree.  Eggs 
and  milk  have  an  evil  reputation  for  encouraging  biliousness.  Fatty 


FOOD    IN    lUI.IUt/SNKSS.  i'j:. 

and  sugary  matters  arc  reputed  to  be  bilious:  but  if  this  be  sn  (and 
the  vie\v  lias  a  basis  of  fact)  it  must  be  indirectly  ami  not  directly. 
If  the  readily  o.\idisal)le  hydro-carbons  attract  the  oxygen  of  the 
bodv.  the  less  oxidisable  albuminoids  will  be  left  over,— the  a-ln-s 
or  cinders  of  the  body-combustion. 

Farinaceous  matters  and  vegetables  should  form  the  staple  diet- 
ary, accompanied  by  a  certain  amount  of  fat:  the  amount  \arvinir 
with  the  season,  climate,  and  locality.  In  temperate  climates  a 
certain  amount  of  the  concentrated  fuel  food,  the  hydro-carbons,  mav 
be  required.  In  tropical  countries  the  dietary  cons.sts  of  carbo- 
hydrates only,  with  advantage.  The  ^astronomic  proclivities  mav. 
however,  u'o  in  another  direction:  but  reason  must  be  brought  to 
bear  upon  them. 

This  view  of  the  dietary  appropriate  to  bilious  persons  will  strike 
manv  readers  as  heiiiLr  novel,  and  so  antagonistic  to  prevailing  opin- 
ions as  to  savour  of  unsottndness.  The  testimony  furnished  bv  mv 
limited  experience  may  seem  insulHcient  to  warrant  it  bein^r  put 
forward  so  contidentlv.  If  the  experience  has  been  limited  and 
recent  it  has  at  least  been  convincing — so  far  as  the  writer  is  con- 
cerned, h  is  one  of  those  matters  which  can  be  reasoned  upon 
rather  than  demonstrated.  And  if  the  reader  remains  incredulous 
tin-re  seems  to  the  writer  no  means  of  convincing  him.  If  he  him- 
self be  planned  with  biliousness  let  him  p'ivc  the  matter  a  fair  trial, 
and  note  the  result.  There  are  manv  matters  which,  if  they  had 
had  to  wait  till  they  could  lie  proved  to  a  demonstration  before  they 
were  launched  into  the  world,  would  have  remained  unborn.  On 
t  he  other  hand  a  sweeping  change  of  opinion  and  pract  ice  must  have 
some  solid  foundation  before  its  propounder  can  expect  the  w<>rid 
to  accept  it.  The  arguments  <;-i yen  in  this  chapter  seem  deserving 
of  attention,  and  the  verdict  of  the  world  can  be  awaited  with  some 
confidence.  My  experience  has  iroiie  in  the  direction  that  what  is 
sound  in  theory  works  well  hi  [tract  ice. 

The  bilious  person  should  avoid  the  e^'irs  in  the  traditional 
breakfast  -  bacon  and  e^s — taking  the  fat  of  the  bacon  by  prefer- 
ence. Then  if  there  be  anv  tish  some  of  a  should  be  eaten.  In 
summer  some  lettuce  or  salad  mav  lie  added:  in  winter  some  fruit, 
especially  t  he  apple.  There  exists  no  real  objection  to  some  cream 
and  siiLrar  l>ein'_r  added  In  the  tea  or  cotl'ee.  Then  the  much  should 
consist  of  some  s'Uip  <»r  fish  with  weii-mashed  potatoe-  or  other 
vegetable,  and  "  pulled  bread  "  or  biscuits.  I)inner  should  consist 
of  some  lish  or  chicken,  a  vegetable  course,  milk  pudding,  and  bis- 


L'4o'  MAM'AL    OF    DIKTKT1CS. 

euit  anil  butter.  Such  \vas  the  dietary  on  which  :i  gentleman  whose 
liver  gave  him  niueh  trouble  got  well,  after  being  under  several 
physicians  of  repute  without  avail.  On  his  usual  dietary,  \vhieh 
embraced  a  considerable  quantity  of  lean  meat,  he  grew  worse  and 
lost  tlesli.  This  is  a  common  story.  \Vlieii  the  live!1  cannot  carry 
on  the  proper  metabolism  of  proteids  into  the  serum-albumen  of 
the  lii/niir  xniirjninix,  but  breaks  them  down  into  bile  acids  or  urine 
solids,  the  tissues  go  unfed.  In  fact  the  albuminoids  consumed 
"  o-o  to  feed  t he  d isease  and  not  the  patient."  to  use  an  old-fashioned 
and  time-honoured  expression  now  getting  lost  sight  of  too  much. 
Of  course  it  is  well  to  raise  the  tone  of  the  liver  bv  resort  to  hepatic 
stimulants  at  the  same  time.  Hut  by  reducing  the  demand  upon 
the  liver  as  regards  its  function  of  dealing  with  albuminoids  it  can 
perform  its  work,  and  normal  metabolism  goes  on.  The  conse- 
quence is  the  bodv  is  once  more  fed  and  the  biliousness  relieved, 
i.e..  the  proteid  matter  is  going  to  its  wonted  destination — the  tis- 
sues, and  less  bile  acids  are  formed.  licee.ntlv  a  well-known  writer 
of  fiction  came  under  my  care  with  a  tongue  covered  with  a  thick 
fur  deeply  stained  with  bile,  and  lithates  in  her  urine.  She  too 
had  been  losing  llesh  and  getting  Worse  on  a  meat  dietary  with  some 
alcohol  the  proper  dietetic  means  to  get  strong  in  popular  belief. 
She  adopted  my  suggestions  with  quick  and  prompt  relief,  and  got 
well  most  satisfactorily.  When  the  liver  is  out  of  order  the  ordi- 
nary dietetic  means  for  gett  in^r  strong  are  rather  mischievous  than 
useful.  It  is  not  what  is  swallowed  but  what  is  digested  that  is  the 
question.  Primary  digest  ion  goes  on  in  the  alimentary  canal,  and 
secondary  digestion  or  elaboration  is  performed  by  the  liver.  Food 
niav  be  taken  and  digested,  but  if  the  elaborating  action  is  defective 
nutrition  fails,  just  as  much  as  if  food  were  withheld  in  the  first 
place.  \\hcn  the  bodv  is  starving  from  liver  inadequacy,  to  force 

•  1  . 

down  liberal  quantities  of  generous  food  is  to  overtax  the  liver  and 
hamper  its  action  still  further.  Food  rich  in  carbo-hydrates,  and 
containing  but  a  small  proportion  of  albuminoids,  is  that  which  is 
rcallv  indicated  and  required.  Th''  appetite  may  be  feeble  ami 
capricious,  the  palate  mav  be  daintv  and  have  its  preferences;  these 
mav  be  met,  but  after  all  the  function  of  the  liver  must  be  remem- 
bered: and  with  it  the  true  body-needs. 

( i  rape  sugar,  the  fuel  food  of  t  lie  body,  must  be  supplied  in  sutli- 
cient  quantities.  Albuminoids  for  tissue  repair,  too.  are  required; 
but  the  amount  actually  necessary  for  that  end  is  but  small.  All 
beyond  the  bare  necessaries  are  superfluous  and  only  hamper  and 


K()()|)    IN    mi.KH  SNKSS.  •_'  1  , 

embarrass  tin-  liver:  and  increase  the  amount  of  In!.-  acids,  or  urn:'' 
solid.-,  as  the  case  mav  In-.  That  i-  tin-  lc.--on  taught  us  hv  inoiii-ni 
advances  in  phvsioli>".-y  ami  clinical  medicine. 

This  is  all  rank  heresy  in  t!ic  opinion  of  the  people  at  larjv. 
\\'lu-!i  a  person  is  below  par.  plentv  of  animal  fooil  and.  jj-uo-l  \\ine. 
tonic-  with  iron,  arc  the  things  to  jjvt  him  up  certainlv  in  1110-1 
cases;  Itnt  when  the  liver  i-  involvci]  there  i.-  an  error  m  the  e.jiia- 
tioii.  So  lonir  as  the  liver  is  competent  to  it-  work,  .-o  Imi^the 
eijiiation  is  correct;  but  when  the  liver  i-  uneijual  to  it-  w-irk  this 
regimen  but  further  embarrasses  it.  The  number  of  stones  i-.M 
one  of  the  failure  of  this  plan  to  vvt  them  strong.  bv  different 
patients,  is  conclusive.  A  number,  too,  furnish  .-nine  curious  corrobo- 
rative testimoiiv.  Thev  hrin'_r  a  specimen  of  urine  for  examination 
in  a  bottle:  and  not  infrc<|Uently  that  bottle  has  on  it  in  rai-ed  let- 
ter- "  (Quinine  and  Iron  \\iiie."  It  has  signal! v  failed  m  their  cases. 
A  look  at.  the  tongue  and  a  few  well-directed  questions  soon  lighten 
the  matter  up:  and  on  a  different  regimen,  dietetic  and  medicinal, 
improvement  set-  in.  Hut  tlfse  persons  are  often  hard  to  convince 
At  !ir.-t  siu'ht  it  does  seem  an  odd  way  to  increase  the  strength. 
\  i/..  cutting  down  the  food,  and  especially  the  animal  food.  15iit 
the  alteration  is  soon  felt.  '•  She  stoops  to  r<iii(|Uer."  And  tii.s 
mano-uvre  can  be  [iractised  witli  satisfactorv  rc-u!ts  in  hi'pat;c  in- 
udeijiiacv.  No  chain  i.-  stronger  than  its  weakest  link.  The  appe- 
tite mav  be  fair,  the  -tomaeh  ("ipablc:  but  the  liver  is  weak.  The 
nutrition  is  defective  usually  when  the  liver  i-  incapable,  and  til-- 
appetite fads.  That  is  Nature's  wav  of  a!  taming  a  new  balance  b\ 
"  levelling  down."  Hut  an  appetite  is  held  to  lie  a  man".-  inalienable 
ri'^ht:  and  so  lie  tries  artificial  means  to  create  one.  lie  defeats  his 
own  end-.  He  is  thwart  inir  and  traversinv:  nature's  provisions,  and 
s.o  i  he  plan  fails. 

\Vheii  ih--  liver  is  incapable  it  is  we'll  to  reduce  the  demands 
upon  it  to  its  capaeit  ies. 

S'>  much  fur  the  dietarv  in  biliousness. 

Now  about  the  drink.  A  naturallv  feeble  liver  cannot  Lr-'t  on 
•with  malt  li'iiior-.  \\  h«'ther  it  is  ch-'Ia  rnia  or  lith:emia.  malt  l:-jiioi- 
i.-  pernicious:  e.-peciallv  uilh  jiersons  of  the  "Arab"  l\pe,  /.«.. 
hii;'hlv  developed  nervous  sv-tem  and  small  vi>ccra.  Malt  li-jiiors 
prepared  liv  the  !;.n'_;-i  ;-h  sv>tem  of  brewiiiL;'  are  speciailv  injurious 
to  an  incapalile  nr  sen-itivc  livci1.  The  beer-  breue.l  upon  the  (it  r- 
man  or  lair-T  system  are  le-s  objectionable;  and  mans  '  li\eri-h" 
pei--on-  can  drink  beer  on  the  ('ontincnt  \\'h"  cainiot  toudi  it  in 


MAM'AL    OK    D1KTKTICS. 

Kngland.  Generous  Ay ines  too  have  an  evil  influence.  The  wine 
must  lie  pooi-  for  most  bilious  persons.  Often  even  wines  must  be 
foresworn  and  some  weak  spirits-and-water  form  the  sole  beverage 
or  food  adjunct. 

Abstinence,  both  as  to  meat  and  drink,  must  he  the  rule  with 
persons  who  possess  an  insufficient  liver. 

This  may  seem  a  hard  conclusion,  but  it  is  a  simple  expression 
of  the  facts.  How  far  people  can  inherit  an  insufficient  liver,  is  a 
matte!'  about  which  there  is  not  much  doubt:  we  know  gout  runs 
in  families,  and  so  docs  biliousness.  lias  the  advance  of  eivilixa- 
ti"ii  a  deleterious  effect  upon  the  viscera  ?  Does  the  heir  of  all  the 
ages  ilnd  amidst  his  rich  inheritance  a  waning  capacity  in  the  liver? 
It  would  seem  so.  at  least,  in  many  in.-tances.  There  is  no  apparent 
impairment  in  the  physique  of  some  families  whose  history  is  known. 
as,  for  instance,  the  reigning  family  in  Kngland.  Uut  while  this  is 
([iiite  true  of  some  families,  there  is  much  evidence,  and  accumu- 
lating evidence  too.  that  when  the  fat  hers  have  eaten  sour  grapes 
the  children's  teeth  are  set  on  edge.  Dr.  .Murchison  follows  Dr. 
P>udd  in  thinking  most  persons  have  competent  livers,  but  "in 
other-  the  liver  scons  only  ju>t  capable  of  performing  its  functions 
under  the  most  favourable  conditions,  and  it  at.  once  breaks  down 
under  adverse  circumstances  of  diet,  habit  or  climate.  This  innate 
weakness  of  the  liver  is  often  inherited.  The  person  is  horn  with 
a  teudeiiey  to  biliary  derangements." 

\\hen  a  person,  man  or  woman,  inherits  an  insufficient  liver, 
gastronomic  indulgence  i.-  thereby  forbidden  under  a  penalty. 


('II. \PTKR    XXXIII. 

FOOD    (JIVKX    OTHFRWISF    THAN    I5Y    T1IF.    Mol'TII. 

Tn  KKI:  are  certain  morbid  conditions  in  which  it  becomes  neces- 
sary to  f  red  the  patient  otherwise  than  by  the  month.  Kspeciaily 
does  this  becomes  necessarv  in  acute  disturbances  of  the  stomach. 
There  arc.  however,  other  circumstances  where  such  alimentation 
becomes  desirable.  Sometimes  the  appetite  is  so  small,  or  tile  dis- 
taste for  f 1  so  stroii-;.  that  the  amount  taken  bv  the  mouth  i.-  in- 

.-iiHicient   for  the  wants  of   the  system.      I'nder   such   circumstance- 

it    1 tines   desirable    to   eke  out   these   scuntv  meals    by  some    t',,,,d 

ofiveii    /»•/•    /'ii'ti/ni.       I'nder    other    circumstances,    especiallv    with 
marasmatic  children,  it  is  well  to  use  inunctions  with  oil. 

Before  proceeding  to  describe  nutrit ive  enemata  and  tlieir  con- 
stituents, it  mav  be  well  to  consider  some  anatomical  and  phvs'.o- 
lo^ical  facts  which  will  piide  us  in  practice.  \Vheu  food  i-  iriveti 
bv  the  mouth  it  meets  with  the  (lip-stive  ferments;  tirst.  the  saliva: 
.-ecoiid.  t  lie  gastric  juice;  third,  the  pancreatic  secretion.  Tin-  lar^e 
intestine  has  none  of  these.  The  seeondarv  digestion  in  thecoion 
i-  somewhat  of  a  misnomer,  and  as  such  misleading.  "  '  >f  the  par- 
ticular changes  whiidi  take  place  in  the  larvv  intestine  we  have  no 
detinue  knowledge,  but  it  is  c \ceed in^lv  probable  that  ill  the  volu- 
minous ca-enm  of  the  herbivora  a  lars/e  amount  of  digestion  of  a 
peculiar  kind  jnu-s  on.  ^Ye  know  that  in  herbivora  a  considerable 
ipiantityof  ci'llulose  disappears  in  passing  through  the  canal,  and 
even  in  man  himself  some  is  probablv  digested.  \\eare  driven  to 
suppose  that  this  cellulose  ditn-stion  is  carried  on  in  the  iarp-  in- 
testine,  thoiiLfh  we  know  nothing  of  the  nature  of  the  a^eiicv  bv 
which  it  i-  ell'ecte,!.  The  other  digestive  idian^es  ;ire  probably  of  a 
fermentative  kind.  15  e  that  as  it  mav.  whether  (litest  ioii,  proju-rlv 
so-called,  is  all  but  complete  at  the  ilio-co-cal  valve,  or  whether  im- 
portant chanp's  .-till  await  the  chvme  in  the  larger  intc-niic.  the 
chief  characteristic  of  the  work  done  in  the  colon  i-  absorption." 
l.M.  Footer.  F.  U.S.) 

The  only  matter  we  arc  certain  about  is  the  ah-m-pl  inn  of  soluble 
matter.  Staridi  must  then  be  converted  intn  soluble  ju-o'luct  s  for  a 


id"  MANUAL   OF    IMKTKTIC'S. 

nutrient  enema.  IVoteids  must  lie  converted  into  peptones  for  the 
same  reason.  ('./'.,  that  there  is  absorption  certainly.  As  to  fat.  it 
is  highly  questionable  how  far  it  is  of  use  in  a  nutritive  enema. 
Fat  is  emulsionisrd  in  digestion  and  in  minute  globules  passes  into 
the  mouths  of  the  laeteals  in  the  intestinal  villi;  which,  as  M.  Fos- 
ter puts  it.  mav  he  said  to  '"Cat  the  fat  globules."  lint  the  intes- 
tinal villi  cease  at  the  ilio-co'eal  valve;  and  therefore  the  fattv  mat- 
ters of  nutrient  enemata  can  he  of  little  nse.  Tins  is  an  important 
matter,  on  \vliidi  it  is  \vell  to  have  clear  ideas.  Bidder  and  Schmidt, 
in  a  case  where  t  here  was  a  duodenal  list  nla.  found  that  "  Fats  intro- 
duced into  the  lower  part,  where  they  could  not  be  acted  upon  either 
t>v  the  bile  or  the  pancreatic  juice,  were  but  slightly  digested  "(M. 
l-'oster).  There  must,  however,  exist  some  other  m<>de  by  which 
fats  can  leave  the  alimentary  canal  (probably  as  soaps)  for  "  the  por- 
tal vein  during  digestion  contains  more  fat  than  the  general  venous 
blood."  the  same  authority  tells  us.  It  can,  however,  not,  so  far, 
be  shown  fhat  fat  can  pass  through  the  walls  of  the  larp-  intestine. 
The  same  authority  quotes  from  Bauer — "Absorption  from  the  larire. 
intestine  after  injection  /»'/'  annul,  or  through  a  fistula,  has  been 
observed  not  only  in  the  case  of  soluble  peptones  and  su^ar  but  also 
in  that  of  the  white  of  et^.  caseine,  and  starch."  Hut  there  is  no 
mention  of  absorption  of  fat.  Consequently  we  may  sty  that  fat  is 
practically  useless  in  a  nutrient  enema  because  it  is  not  absorbed; 
and  that  when  the  svstem  needs  fat  it  is  of  no  avail  to  MJIVC  it  by 
enemata. 

Of  old  a  nutrient  enema  consisted  of  beef  tea,  the  yolk  of  an  enir. 
and  milk.  Of  these  difl'erent  materials  prohably  the  extractive- of 
the  lieef  tea  and  the  milk-supir  of  the  milk  alone  were  absorbed— 
to  any  extent  at  least.  If  brandy  were  added,  probably  it.  too.  was 
absorbed.  Of  the  other  matter,  as  the  casein  and  egtr  albumen,  some 
were  po--sibl v  absorbed. 

The  bowel  really  is  adapted  only  to  the  absorption  of  mailers 
which  have  been  digested  above  in  the  small  intestine.  If  matters 
be  introduced  into  it  from  the  other  extremity,  they  ou^'ht  to  have 
been  subjected  to  a  like  action  previous,  to  their  occupation  of  the 
lower  bowel.  The  dio-eo'eal  valve  bars  their  entrance  into  the  small 
intestine  \vhere  digestion  -as  dilTerent  iatei]  from  mere  absorption  — 
take-  place.  If  not  prediLTested  they  arc  not  fitted  for  absorption. 

Nutrient  enemata  then  can  conveniently  consist  of  soluble  carbo- 
hydrates and  peptone-.  The  disagreeable  L,rlue-like  flavour  of  most 
peptone^  constitutes  no  object  ion  to  t  heir  use  here.  I  ndeed  peptones 


FOOD    (JIVKN    OTHKKWISK    THAN     I'.Y    Till!    MolTH.          i.'.",  1 

and  peptonised  ^rui'is,  arc  excellent  matters  for  nutrient  e>i<-mata. 
Malt.  preparations,  mail  foods,  and  malt  c\ira<-;~  arc  admirable 
material  for  ciicmata.  ( )r  inilk-su<*;ir,  or  dextro-saceharum,  or  ,-\.->i 
hevulose  suijar,  especially  as  treacle. 

When  acute  irastric  disturbance  is  on  foot,  then  the  nutrient 
enema  should  consist  of  soluble  carbo-hvdrates,  meat  peptones,  and 
if  necessary  a  little  hrandv.  \\lien  there  is  anorexia  and  a  febrile 
state  co-existent,  the  utility  of  albuminoids  is  less  certain:  as  prob- 
ably no  histo^vnesis  then  ^oes  on  (as  pointed  out  in  a  previous  chap- 
ter). P>ut  of  the  utihtv  of  matters  ftirnislnnir  Lrrape-suLrar  to  the 
system  in  its  hour  of  need  there  can  be  no  epic-lion.  hVceiiKv  in 
a  case  of  chronic  bronchitis  and  emphysema  the  appetite  dropped 

I  LI  II 

dangerously  low  even  for  a  ladv  in  lied  in  a  \varm  bedroom.  Here 
a  nutrient  enema  of  .Mellins's  Food  and  pcptonised  milk  niirht  and 
morning  just  made  the  difference  betwixt  slow  starvation  and  im- 
provement. I  could  have  liked  to  have  something  I"  say  about  the 
utility  of  nutrient  eiicmata  in  the  attacks  of  acute  ^a-trie  distur- 
bance in  phthisis;  but  unfortunately  am  not  in  a  position  to  say 
much.  ( »n  n  nriuri  grounds  there  is  a  irreat  deal  to  say :  but  lio\\-  the 
actual  facts  will  turn  out  is  not  so  certain.  If  readers  of  this  work 
Avho  try  nut rient  enemata  in  such  eases  would  put  their  experience 
on  record  we  should  soon  have  a  body  of  evidence  which  would  be 
highlv  valuable,  whether  for  or  against.  If  favourable,  our  hand- 
are  strengthened  in  a  vcrv  Irving  crisis.  If  it  turn  out  but  a  broken 
reed  it  will  be  well  to  know  it.  so  as  not  to  [nit  faith  in  an  untrust- 
worthy measure  at  our  time  of  trial. 

A  larirc  tablcspoonful  of  soluble  carbo-hvdratc  as  malt-extract, 
or  .Mellins's.  or  other  malt  preparation,  or  milk  su^ar.  or  a  small  tea- 
spoonful  of  meat  peptones  in  an  ox.  of  warm  water,  would  form  some- 
thing like  what  is  rci|uired  for  a  nutrient  enema.  Such  a  small 
liulk  would  probably  lie  well  tolerated  by  the  not  verv  sensitive  larue 
intestine.  And  repeated  twice,  thrice,  or  oftener  daily  would  make 
a  substantial  addition  to  the  body-income. 

lh»w  IOULT  nutrient  enemata  mav  be  continued  depends  upon  the 
condition  of  the  anus.  If  tins  become  very  .-ore  and  sen-iti\c  they 
mav  have  to  be  discontinued  after  a  short  trial.  (The  utility  of  an 
opium  suppository  in  such  anal  sensitiveness  surest  s  itself,  or  -oine 
other  local  application).  If  the  anus  remains  insensitive  the 
nutrient  enemata  can  be  continued  for  a  longer  pei'iod.  <  >n  •!:; 
matter  we  have  much  to  learn.  \\  hen  we  ^ive  an  enema  to  t;;;-h 

out  the  contents  of  the  lai'LI'c  intestine  We  |V<|Uire  bulk  to  di-tclid 
th"  pouches  of  the  colon  in  wllieh  the  t'ace<  lod^r.  I',;;!  for 


L'.VJ  MANUAL   OF    DIETETICS. 

nutrient  enemata  a  small  hulk  is  desirable  iu  order  that  it  may  bo 
retained  and  not  he  cast  forth. 

\Ye  can  sec  a  great  future  for  nutritive  enemata  no\v  that  tho 
proper  materials  for  them  can  readily  he  procured;  and  increasing 
knowledge  will  teach  us  many  minor  points  to  he  attended  to,  of 
which  probably  something  can  be  said  in  a  future  edition. 

Very  recently  '"rectal  alimentation"  by  nutrient  suppositories 
has  been  advocated;  and  in  some  cases  has  been  found  useful.  The 
component  factors  of  nutrient  suppositories  will  be  limited  by  the 
anatomico-physiological  facts  of  the  Avail  of  the  colon  and  its  capaci- 
ties (pointed  out  in  tho  early  part  of  this  chapter),  (-specially 
what  is  said  about  the  non-absorption  of  fat  by  the  bowel.  That 
nutrient  suppositories  of  soluble  carbo-hydrates  and  peptones  may 
come  to  have  a  high  practical  value  seems  eminently  probable. 
.Kven  if  these  nutrient  bodies  have  but  a  limited  scope,  this  may 
still  be  enough  to  give  them  an  incalculable  value  in  times  of  emer- 
gency, when  life  is  quivering  in  the  balance  and  a  triile  Avill  cast 
the  beam.  And  it  is  in  our  capacity  to  provide  these  apparently 
little  matters  in  the  nick  of  time  which  constitutes  a  great  part  of 
the  utility  of  the  medical  profession.  Sometimes  a  practical  grasp 
of  the  exigencies  of  the  case,  and  the  knowledge  how  to  cast  the 
quivering  balance,  far  outweigh  in  real  value  an  elaborate  but 
sterile  diagnosis  of  minutia1  in  such  hours  of  need.  Kmergencies 
are  indeed  often  the  test  not  only  of  the  possession  of  knowledge1, 
but  of  the  capacity  to  make  use  of  it.  A  nutrient  enema  at  the 
proper  moment  may  have  life  or  death  hanging  on  it. 

Of  hypodermic  injections  of  nutritive  fluids  little  can.  bo  said. 
Accounts  of  such  methods  of  feeding  have  been  published  doubtless, 
chiefly  by  foreign  physicians;  but  they  appear  rather  to  belong  to 
the  curiosities  of  medicine  than  as  part  of  the  working  apparatus  of 
dailv  practice.  For  matters  of  small  bulk,  as  potent  medicines, 
the  injection  syringe  is  of  priceless  value;  but  of  concentrated  foods 
adapted  for  injection  purposes  we  know  nothing. 

Transfusion  of  blood  scarcely  comes  under  the  heading  of  die- 
tetic.. 

Then  come  inunctions  of  oil.  How  fat  is  absorbed  by  the  skin 
is  a  matter  on  which  little  is  known;  at  least,  nothing  about  it  is 
known  to  me;  but  about  the  fact  tin-re  can  be  no  question.  \\  hen 
attached  to  the  \,Vest  London  Hospital  numbers  of  poor  starvelings 
wen- amon^f  the  out-patients.  \Aith  manv  of  these  mites  the  addi- 
tion of  some  cod-liver  oil  to  their  scanty  fare  caused  much  improve- 
ment. "With  others,  however,  it  became  necessary  to  resort  to  oil 


FOOD    (JIVK.V    oTIIKKWlSi:    THAN    i:V    Till!    Mot 'Til.          1' .'.:', 

fnnnctions..  The  eiTects  varied;  some  babies  be^an  in  improve  at, 
once  and  rapidlv,  while  with  others  the  proirres--  wa-  nni<-h  .-lou,;-. 
Dili  mi  tin-  wh<>lr  the  results  were  sat  isfactnrv. 

I  u  some  instances  such  inunctions   have  been  found  useful    \\i;h 
adults  where  the   assimilative   organs   W<TC   uuenua!    to    much    Wi.rk. 
It  is  imt  unusual  l'»r  phthi.-ieal  patients  t<>  appiv  cod-liver  oil    to   :he 
chest  when  it  is  not  ivadilv  taken  liv  the  in  OH  th.      The  nil  i-  absorbed 
and  does  p>od,  Imt  the  plan  H  an  un-avourv  one. 

When  oil  inunctions  ai'e  indicated  the  rn.nu  shouM  lie  made 
warm  and  all  drauirhts  excluded;  else  the  exposure  mav  he  injuri- 
ous. (A  pooi-  little  infant  ivadilv  1'eels  nnylieat  loss).  Then  lip- 
skin  must,  he  made  perfect  Iv  clean  with  hot  water  and  soap,  with  a 
piece  of  llanui'l  or  a  sponge.  Aftfr  this  has  ln-en  done  the  oil  <-aii 
tie  applied.  It,  is  well  to  allow  tin-  oil  t<>  u'ei  warm  hv  th<-  iii'e  while 
the  preliminarv  operat ions  are  LT'ii"^  on.  Aliout,  half  an  ounce  ia 
tahlespoont'ul)  is  emui^li  at  once.  Ahoiit,  a  teaspoonful  should  he 
ponreil  into  the  palm  at  once,  and  this  should  lie  ruhhed  well  iu  over 
the  trunk  and  1  mil  PS.  1  low  much  of  this  is  ahsorhed  I  do  no;  k  rmw. 
The  undergarment  of  course  hecomcs  oily,  and  how  much  ahsorp- 
t;on  ^-oes  on  after  the  I'lilihin^  1  do  not  know.  I5ut.  ho\\c\cr  it 
comes  ahout,  the  process  i;ives  sat isfaetorv  re-nits. 

Adults,  or  children  of  larger  growth,  who  i-eiju;re  od  inunctions 
are  usuaiiv — or  ouirht  to  he- — in  hed.  (in  order  to  reiluce  the  liodv- 
expenditure).  A\'ith  these  it  has  been  found  convenient  to  anoint 
one  half  of  the  bodv  at  once;  taking  the  other  nmictv  in  turn.  In 
certain  cases  this  method  of  feeding  proves  verv  useful.  Ini-oid 
weather  such  coating  of  oil  is  fouii'i  verv  comfortable.  It  is  not  a 
cieanlv  method,  however,  and  has  nothing  to  he  said  lor  it  except, 
its  utilitv  in  t  itncs  of  need. 

Such,  then,  are  the  methods  of  feeding  otherwise  than  bv  the 
month.  Thev  are  all  oliject  lonablc  and  repugnant  to  the  feelings. 
and  to  sensitive  pei'soiis  sim[>lv  intolei'aliie.  Still  there  arc  c;rc:;m- 
stances  under  which  these  methods  are  advar.ia^eous.  ami  ; 
to  know  of  them  and  about  them  when  the  emergency  arrive-.  As 
to  the  choice  of  o;l.  [ iroba bl v  an  ani ma  1  oil  is  more  eas;i v  ab.-orhe'i 
than  a  vegetable  oil.  Of  these  neats-foot  oil  is  the  lea-;  o!Teu-:\e. 
\\  hen  this  is  oll'ensivc  then  olive  oil  can  lie  resorted  \».  l':'o;.a''.v 
t  his  was  the  oil  useil  bv  the  earlv  Christian-:,  who  whin  -;ck  \ 
anointed  with  oil  and  praved  over  bv  the  elders  »f  the  Church,  ac- 
corii  i  n^r  to  St.  ,lame<. 

Iiuim-tinns  of  oil  are  less  fre(|uentlv  called  for  than  nutr.i;\e 
enemata,  which  arc  often  <if  much  service. 


roxcLrsroN. 

Tin-:  perusal  of  the  foregoing  chapters  Avill.  it  is  bolicvecl,  con- 
vince most  readers  that  there  is  inueli  more  to  lie  said  for  food  and 
feeding  in  disease.-  alike  in  acute  maladies  and  mere  chronic  affec- 
tions.— than  at  first  sight  seems  probable.  To  kno\v  what  food  is 
required  in  eacli  morbid  condition  is  a  matter  too  little  attended  to 
in  medical  teaching.  Medical  teaching  is  conducted  in  hospitals, 
and  in  hospitals  for  obvious  reasons  the  dietary  is  arranged  in  scales 
of  varying  liberality.  This  unavoidably  leads  to  routiiu — hard  and 
fast  lines  which  are  not  elastic.  Consequently,  dietetics  are  matters 
picked  ii}>  by  the  medical  man  mostly  from  his  private  patients;  and 
probably  his  first  real  lessons  come  from  some  intelligent  patient,  or 
friend  of  a  patient.  P>eef  tea  he  knows  from  the  hospital,  and  milk 
ami  lime-water  or  seltzer  water;  but  the  rest  he  acquires  as  he  can. 
Some  men  pick  up  a  great  deal,  others  but  a  little.  The  Professor 
of  ( >  rvalue  Chemist  rv  tells  him  little  or  nothing  about  the  food -value 
of  food;  the  Professor  of  Physiology  describes  digestion  to  him.  but 
docs  not  describe  the  various  forms  of  food;  the  Professor  of  Prac- 
tice of  Phvsic  gives  him  directions  as  to  the  choice  of  medicines,  hut 
probably  never  mentions  food  except  when  discoursing  on  diabetes; 
the  Professor  of  Materia  Medica  gives  a  careful  account  of  the  dif- 
f' TCI  it  members  of  the  Pharmaeopo'ia,  including  their  actions  within 
the  bodv.  but  as  for  food,  he  has  no  word  to  say;  while  the  Professor 
of  S;;n;vrv  mav  speak  of  a  bread-poultice  or  a  beef-steak  fora  black 
eve;  but  t  hat  is  all. 

If  some  systematic  lectures  were  delivered,  even  if  only  of  an 
elementary  character,  tin-  student  Avould  have  some  broad  rules  to 
guide  him  in  his  choice;  instead  of  being  left  prettv  much  like  a. 
ship  without  a  rudder.  It  mav  lie  thought  bv  some  readers  pre- 
MimptiioiH  fora  person  n.it  actually  engaged  in  medical  teaching  to 
criticise  the  existing  silence,  or  to  make  surest  ions:  hut  it  does 
seem  to  me  t  hat  instead  of  getting  up  pharmacology  mid  the  appear- 
ance of  crude  di'uu's  it  woihd  be  well  to  substitute  some  account  of 
foods  and  feeding.  When  the  medical  man  hail  to  choose  and 
select  his  raw  material,  from  which,  as  an  apothecary,  he  prepared 
extracts,  tinctures  and  infusions,  then  such  knowledge  certainly  had 
it  >  value. 


C<  >N(  I.I'SH  ».\. 


lint  no\v-;i-il:iys  a  medical  man  trusts  his  chemist  and  drm-r'-rl-' 
for  his  medicines,  and  rarely  even  makes  a  fresh  inf'i-io:,.  (,,..,,.. 
(jiU'Utly,  this  part  of  his  stmlii's  is  uselc.--.  anil  merelv  hiirdeii-ome  t» 
tin'  .-indent,  and  an  inroad  upon  time  which  has  manv  u'emand- 
upon  it.  and  which  is  too  precious,  in  every  wav.  to  he  uasted.  If 
tliis  time  were  devoted  to  some  account  of  food  in  health  atid  -i''k- 
ne-s;  of  the  preparation  <>f  fund  in  relation  to  its  digest  ion;  of  pre- 
pared f 1  for  infants  and  invalids  and  those  aetuallv  ill:  of  the 

p  reddest  ion  of  foods;  of  the  relation  of  various  i'oods  to  sundrv 
niorliid  conditions;  it  would  he  much  hetter. 

Possihly  the  ahseiice  of  sudi  lectures  ';-  to  -ome  extent  due  (o 
the  fact  that  a  text-hook  availalile  for  such  lectures  did  not  exist. 
I>r.  1'avy'.-  hook  is  most  interest  inv;  and  iustnietive;  and  the  same 
mav  lie  said  of  Kini:  Chamhers's  Manual  of  I>iet  in  Health  and 
Ihsease;  hut  neither  form  svsteiuatie  treatises  suitaliie  f^r  lecturing 
piirjioses.  The  \\iMter  lias  some  hope  that  the  present  work  has 
so i HC  claims  to  lie  such  a  honk:  hut  this  may  I.e  no  more  than  the 
vanitv  which  is  sud  to  clini;'  to  autliors. 

Lectures  ;av  delivend  Vearlv  hefore  tile  Koval  ( 'ol'e^e  of  1'hvsi- 
eiaiis  of  London,  and  we  mi^ht  have  thought  that  the  authorities  of 

tile     College     Would      have     foil  lid     Some     one     to     lake      Up     tile     Sill'jecl 


teaehiiiL:'.  When  a  lish  smells  about  the  head  it  is  useii  ss  to  look 
for  fre.-hnes<  at  the  tail,  savs  a  Turki-h  pmverh,  and  so  lon^-  as  this 
niiinj;  hodv  in  mattei-s  medical  maintain-  an  att;tud,e  of  hiatik  and 
supine  indilTereiiee  on  the  mailer  of  fund,  so  Ion--  nothinir  w;:l  he 
i  joiie.  A-  an  exam  in  MIL;'  hod  v  a  change  would  at  om-e  he  inar.Lnii'ated 
if  a  (juestion  on  I  >ietetics  were  asked  at  the  higher  examination  fuj- 
the  ineiiihership:  l>ut  of  this  there  seem-  as  vet  no  pro>pi-ct. 

There    is    a    hetter    prospect     ill     tile    I'llited    State<.    w!|e|-e    the    Hlhject 

of  1  >ietet  ic>  is  in  a  m  uc  ii  more  advanced  coin  i  it  ion.  '  The  .luurnal 
of  ii'eeoiistniel  ives "  ;.  ;1  step  forward  which  ail  inu-t  ha;,  with 
satisfaction:  wlnle  the  ettorts  of  the  enterprising  tirms  who  prepare 

various  form-  of   f i  are  \\-nrthy  of  ail  commendation.       A-  -oun  a< 

the    knowledge   of    foods   and    lio\\-    ;u    use    them    com,'-   ahrc:,-;    tiie 
various  ['reparation-  in  the  market,  then  a  revolution  ;n  ;iie  fedim^ 
of    the    .-iek    and    inlirm    w.ll    he    wrought.      And    liie 
eluding:  sentence    is   the  e\]ire-sion    of   Ins  lielief   that  that    much-io- 
he-de.-ireil  rc\olntioii  is  close  at   hand. 


PUBLICATIONS 

OF 

WILLIAM  WOOD  fc  COJI.PAXY. 

XOS.  50  &  58  LAFAYETTK  PLACK. 

XKW  YORK. 


Weisse,  Faneuil  D.,  M.D., 


duain's 


j;i,  K.Ml'.XTS    <>F     ANATOMY.       R—  liL-lLy    WII.MAM    Sn  viii'V,    M.R,    1.1..D., 
r.U.S.    I,.  :  n,l   !•:..   I'miTim-  I'mf  ------  r  ..;'  Anatomy  ami   I'li^i,    ...\   ;:i   I'u'v.  -ity 

('-I,  .....  ,!...:.•!  -MI  :    Ai.i.r.N  Til.  >M  ]•-,  >N.  .M.D..  IJ,.  l').,   !'  !!.>'   I.    ;;   ,'l    I!  .   lv,: 

i''    A  ii.i'-iii  •,    in    tli''    I'ni  viTsit  v    dt'    (  '•  l;i-_:'i  i\v  ;     iui'1    1  .  1  >\v  A  i;  1  <  A  i.i  :l   I,  I    N(  11  \  I  I  i;  . 
A.-i-fiHt    IV..:',.-M,i'  of  I'hy-iuli.-y  in  I'  nivoxily  (',,!  i,  •_,-.!.,  .n.;.  •:..      Ni:-:!,  , 
I  i!'i-':  I'-'l    I'y  r,,!,,',-!    pl.-a.-<    ;ni'l    (ivi-r   (in,,    tii,  ni-aii,  t    nu  r:  .  •.  :  M  :~    -:i   \>.  ,  ..  ,  i        In 
t\'.  "  iinj.i-i'ia!  '--v,)  \-"!mii''-,  7  17  :in,l  '.'  1  1  piucs,  iiiu>lin.       1'ri,-'-.  slO.i"' 


I  l.\,irk,  I  mt  s.i    many  ;«1.  lit  ions     —  T!«  rn^i  nli'  (•'•'  .•  '.'•  ,   1  >•  ; :  -  i 


Wood's  Pocket  Manuals. 


mi.    \\  vrn.Mir.u.    I;I:MI-;M!',I:AXCKI:  ;  ,,,-.  c..m\  i •?    r • 


"  A  vuluaiilu   littl.j   com'diii 


FOR    INDEX   SEE      LAST    TWO    PACES. 


2          ITP.LICATTONS  OF  WILLIAM  WOOD  Ac  COMPANY. 

vl  tultnni  y. 

Ranney,  Ambrose  L.,  A.M.,  M.D., 


PRACTICAL  MKDICAL  ANATOMY.  ACnide  to  the  Physician  in  (be  Study  of  the 
ll.-lations  of  tli.'  Vi-c.-ra  t<>  each  other  in  Health  and  Disease,  and  in  the  Diai;- 
iiosi-  of  the  Medical  and  Sur_ic;il  Condition-:  of  the  Anatomical  Structures  of  the? 
Ib-ad  and  Trunk.  lllu.-trated.  Sold  only  by  subscription.  See  JM^C  54. 

Ellis,  George  Viner,  M.D., 

IT'iY-sor  ,>:'  A:;:uir:.y  in  L'nivcr  ity  (.'nlkvi?,  Lindon,  and 

Pord,  G.  H.,  Esq. 

JLU'STUATIONS  ol'  DISSECTIONS.  Tn  a  Perie?  of  oridnal  colored  ],lat,'s.  ivpro- 
M'litiii-'  t  IP'  di->.  ctioiis  ot'  the  human  body,  \vith  ib'.-crijit  ive  letter-press  The 
d.r:i\\in_s  are  from  nature  by  .Mr.  Ford,  from  ditV''ti'>n-  by  Prof.  Klli>.  Volumes 
I.  and  II.  Containing  tifty-six  fuH-pai,re  ehromo-litho,'raphic  plates.  Soldonlv 
l>y  subsci  iption.  See  jiau'L'  "i4. 

*  -""  When,  in  the  second  si  ries,  wo  succeeded  in  presentiiiLr  our  subscribers  with  "  Savage's 
F'-:ua.f  I','lvic  <  )ruans."  witii  it  s  full-pa^i;  litiioi:rapiiic  plat,-.-,  we  supposed  we  had  reached 
th''  e\ti''-ini'  iinfn  m  reproducing  expensive  books  at  so  lou  a  price,  but  these  two  vohnm  s  of 
Kills  :in-i  l'',ird  far  exceed  even  that.  It  is  simply  wonderful,  and  cannot  fail  to  '•HIIIJH  '  n\,- 
kn,'\vieil _"iii'iit.  of  the  value  ill  this  ••  rios  of  publications.  It  would  have  been  impossible  (,, 
accoinp!i.,h  sr.cii  iesuit>-.  -civc  in  a  lilirary  such  as  th.'s,  in  which  nil  the  volumes  have  an  njitnl 
sale. 

Bock,  C.  E,M.D., 

:     f,  --    r  :C    r.-il    ':  -. 

ATLAS  OF  HI'MAN  AXATO^TY.  With  Explanatory  Text,  f'onlainin- thii  ty-ei  J  i 
ste.-l  j'lat,-,  m,.-t  nf  them  haml-culurcil,  of  the  hones,  muscles,  vessels,  ami 

llel'Ve-;   of  the    lilllliail    body    ;    or_'aiis  of    Sense,    eye,    ear.    !l"-e,    and    tollLTIIe  :     r<  ~\  'V- 

:it'  'i-y  apparatus,  abdon  '  '  ;ui  1  pelvic  viscera,  i>ru'ani/ati'  n  of  Fu-tns.  tin-  teeth, 
•-',  i' ::  • ;  '  .1-1  •  -urinary  oi  an-  of  the  male  and  female.  One  ml ume,  lar^e  .jtn, 
In  ,-iin.  Price,  si."). (to.  Sold  only  by  siib.-cripti.  ,;i.  See  pa-e  Hi. 

Zieglcr,  Ernst, 

I'r    '  •:••.'•.••.     r..:.-.  ••••;.-  r,f  T.ibin.'cn. 

A  TKXT  P.oOK  oP  CKNT.K  A  I.  PATI1OLO(;T(.1AL  A  N'AToMY  AND  PATHO*;  i:\K- 

SIS.      Translated  an  !  edit.    !  f  „•  Kn-lish  students  by  D,.N  \i,  M<  Ai  i-rr.i:.    \.M.. 

M.P,   .    Mi   ml  -•:    of  the    Hoya     Co    [,._',,  of    I'liv-ieiali-   ;  'Fellow  and    Medical    Lectni'.T 

of' St    .!''•('         i  ,.     Parts  I.  n.  vt  III.     Sold  only  hy  subscription. 

s,      pa  'e  ."i:;. 

Holden,  Luther,  M.D., 


Shuter,  James,  F.R.C.S.,  M.A.,  M.B.,  Cantab., 


rrr.LiCATioNs  OF  \\TLLIAM  WOOD  \  COMPANY 

^  1  in  t  tout  >J. 


Delafield,  Francis,  M  D., 

pr.  f<.-.-or  »f  I'Htti.'l   r-y  an. I  ria.-n.'n!  Y.-.U   !::e,  <_'•  •.:.»•<•  ••{  l'hy-:c!;i:n  i:.  i 

Prudden,  T.  Mitchell.  M.D., 


A   HANI>i;i)(>K   01'    1'ATHOl.nCH    \L    ANAT<  >.M  V    AM)    H  1ST<  >!.<  »f  ,  ^ 
IntroehictoTV  Section  on  I',  -i-iii"!  ;•  m  Kxaininati.'ti-  aii'l  :!.••  M.  •  :     •  !-• 
iiu   an  1  examining   I>iM-a-o,l  Ti--i;.--.       (  >:ie  volume,  Svn.  .V.il    p., 
u  i:  h  din.1  huii'lre.l  :ui'  I  tort  y--i\  t.-n_  ravines  fi  »m  "i'L  inai  .  Irau  i;.    -.     1 
lin  bi  ii'li  n.;-.      Price,  ^."I.IMI. 

^  •'  °  The  first  eilitic.il  el'  this  work.  i-n:nic'l  "  Post  -mortem  Examination-,"  v,  -i 
t>)  Mifvc  as  ;i  u,rui.ie  I'.'!'  t  hose  per-  on  s  who  mi_'i't  h;ivc  to  perform  poM  -mor!t  m  .\a:i 

In  this  .-ecoml  edition  the  scope  ol'  the  work  has  t>een  v.-rs  much  .  -\reii  •!••  i.  I' 
U-::.le.l  to  supply  nil  tn<'  nee,  Is  of  stmlrtits  ami  pract  it  loners  \vhn  wi-li  t,.  'Ml  :i  k' 

tile    lesions   III'    .li-ea-e    to    tlial    of   itf    I'linieal    -VMIJit  om-,.         The    lioillt     of   -,  i.   \\    ,.f    t.'le 

I'oie.  is  tliat  of  i  he  j'hy.-.:eiiiii  %\  ho  wi.~h''s  to  tiiul  out  what  are  tin;  le-ion.s  of  t;ie  .li-. 
lie  i.-  111  the  lut'hit  ul  M-i.-in^j,  r:ithi-r  than  :h;it  »i  "lie  pure  patholoji.-t. 

Delafield,  Francis,  M.D., 

I'rnfi-s-i.r  "f   I'.ithoU.L'y  iin.l  rnu-tien;  Mi'.'.i.-inp.  i'   .;OLV  of  I'l'.y-irians  a:i.l  S".'.  .v  .-•;>.  v   -v 

STU  I  )!!•:<    IN    1'ATl  !()[.<)(  IK  'A  L  ANATn.MY.      Volinne  I.,  tiva'iiu     i  li 
sii^'i'-i'ts  :    riithi.sis.    I't-ritmiitis.    I'i-'Uri>v.  I'lu-iniionia.  l'!iuj'\'ei:i  t,  H'.' 
Iji-iiin-liitis,     a:.  'I     Tul'i-n.'uh'.-i-i.       lihi.-n-jit'-'l     witli     ninety--  hi  ee    t\.! 

<liiilliii--Ji;i^e     p'.ates    luaii.-    1>V    tile     t'"'.  '.  •  '\vin_'    Jil'Ui'ev--eS  :      A  11  1  ".  ra  ]  .'|  ,  ;  ,  •.     |'i 

Lrapliie  lleli.it  vpe,  aii'i  Art"ty]  .....  I'  i  >ri_'in;i!  l>ra\vin_-:  \\"  .....  i-eii. 
(  >i  i_i:ial  I  >ra\vin_s  on  the  I'.l  ek.  l',:.-|.  i  MJ-  on  Copper,  |  it  1,.  ,_-rai  •:.-  !';••  ! 
I>ra'.viujs  on  tlie  Stone,  aii'i  !'!.•  >'•  •_  I'apiis  of  Sp'-eiiuei.s.  !|o\  (;  >-,-n 
Irili'  laor.ieei).  -iit  top.  pl:i!.'-  hin_e  i  ,.n  liiiell  ^liai'.l.s.  I'riee.  S'.'II.Mil. 

1'AirU   I.,  Vn'iuiU'  II., 


"  IVi.t'i-ssur    Debifielil's    'Stu.ii's    in    I'atlai-  r  —  Yns    are    oljtaiii'^1     are    a-    l"l! 

lo^-ie-il   Aualoiny,'  to  which   we    have  n  !'•  rp  '1  graphic  phutn-lit  iini;rapiis  frmu  oi' 

MI  I  reipieiitlv  on  t  lie  appi  araiK'e  ot    t  h"  >  1:  !l  ••'.•-  it1,  u's.  iieliot  \  p,  s  f  i  o;.i  on^ina!    It  i\ 

eiiT    paits.    ii;ive   thus    far   IH--H   eiillecte'l    ;:i    :i  en_rr:ivin.,rs  ot  ori'.iinal   i  i;  av,  p._- 

single   ina_r!iiiic"iit   volnine,  royal   oeta\o   M/.  •,  etehin^'s  un  copper.  litl;nur-ip:.-    l' 

an.  I     -np.-rlily     illu>trate,|    with     niue:\    r!:r-,e  ilr;nvi:i-s   <m    the   >tou.-,  ;rt.  .;•.:•- 

full-   an-l   iloudle  ]..i4e    pi.-ites.       The    au;:ior's  i!ra\\  in;;s,     phnto^:  api:-    o!'     -  :  ..    •: 

olij.et     has    lie;  n    to    ileM-rihe    asi'l    liuiin-    •:.••  r..|   lit;.  '  of  t  !n  .~e  h!:;~:  ralions  is  i 

iiiisiMte    lesions   of  ili>e;i«-e    f'lfiTu    tli"    iiiai  -rial  '.vhi!.'  th-'ir  e.\"riitio:i  in  the  uiv.  • 

•.vhich    lias    fall,  n    ini-l'-r  his  own    ulisvrvat  ioi;.  ;i':'niileil  tn  make  t  hem  -p.  .-f:    .     - 

In   'hi>   re-p-et   t  h  •  Look  1,  a-;   a  peculiar  value.  The   sulijeets    specially  l  r.  at.    ;   • 

in  repre-eiil  1  1  ;  ^  1  1  1  •  1  1  v  1  1  i  i  ,  n  1  uork  in   a  \\i'i"  aii'l  \oluiue     are     phtui-l-.     p.  ri" 

c'U'.'t  ull  v  cult  ;  val  "il  tic-lil.     Tne  re-ui'  .-  o''  t  in  -e  pneumonia,     <  mp  ,  •  in  a,      .,•::•'• 

la'io|-s   are   pr.  -"iiteil  for  w:iat    they  ai'e  \v«irt!i  e!iit:s.    til'  rer."i!o-i  ,.       '!'!:•     :     • 

as  <ii  monst  rate,]  l  ,et^.  not  hin.;  moiv  aii'l  not  h-  one   ..f    tins,.   ,  li-.  ;i-  >    i  -    •    :  -    '. 

i':..    i.  •<-.      A-  very  iinnl.  s:ly  >t:it.-,l  l,y  niir  ai;  h.  nsn-.  '.v    iie~   ril-    !    i:i    c 

t.;..r.    hi^   plan    of   ^!  ''.'iy    ••i.'iipl  v   in\o!\  ,-.(   tiie  pi  at  •-.  'has  ^ivii;.,'  I  !•••   r.   i  :•  :    '    • 

foil  .win-  of   Nat  :r,-  wli.-rev.  r  she  mi-ht  lea  i.  of  clinical  as  w.  i!  a.-  pariaO 

(  '.  .n-e.|iiei!:!\  .  in  viewing   th.-  a.lmiraliii-  pres-  .iili'i-ia  n'  le  -ions 
e';'atio,M  ,,('  inieroseopieal  appearances,   \\  .    are          "We    ea-.no'    coji_--;.[  ,1!  .  : 

pr.vi!e_;.  ,1  to  -it.  as  it   wire,   lii.-iije  t  i,.-   ina.-ter  \varmivon    l'i-     r.  -ii.lT-   ••• 

an.  i   a!  most   vi^w  t  he   speeirn.  n-  wit  h    in-    •"/'-.  n.  .r  e,,  n  -,\  .-...-,  .::ir:-  : 

A'1.  1  !••  :••    !"t  ::,s  -ay  th:'f  pfohalily  in  no  -^i:nilar  tn  t  lie  pru^re^-ive   -•  :.i.  n' 

«-..rk  ev.-r  In-fore  p'ihli-h.  il  are  th,-r.   eolle-te.l  p-,t  !,  ..'oL-  1-:.     Tli.    •>.•!; 

i  n;.ii:v  1  -vitii'iM  "li'l  -,a!-::tli|.'  rep:-.-i-!i"iti..n,  ri-t.tM'.y     l..e:Ml.       -.|  I     •-.- 

ol    [iat:io  logical  lesion-    t  iia;i  in  tile   on.    1,,  i   ,re  m.  -ri'  -    is   a    :  •  i  i  :    ;  h  oi    •  .  _  .      !  i     : 

::-.      Tiie   processes   !iy  which  the-e  a.i-uir  iMe  '/'(,    .If  <.'•-.   ;  /, 

Hilton,  John,  F.R.S.,  F.R.C.S. 

I;HST  AND  PAIN.    Ar-mr-  .-:'  i,-  -MI-.S  ,..,  th..  iMt'J  m    -     M. 

I'l,\-i.  '...  -i  •  ,!   II.  -t  :;i  the  T-   :-;:1.  ..' 
Dia.  :i...-!ie  \'-.;\n>-  of  |':i';i.       I  -i:-     \ 


-1  PUBLICATIONS  OF   \YILLIAM  WOOD  £  COMPANY. 

Wagner,  Ernst,  M.D., 


A  ^lAM'AL  OF  <;i:\Ki;AL  I'ATIK  >I,O<  ;  V.  For  tin-  t'so  of  Students  and  Practi- 
tioners nl'  Medicine.  Translated  t'r.'in  tin-  Sixth  (I.Tinan  Kdition  tiv  JOHN  VAN 
I)i  VN.  A.M.,  M.D..  Professor  of  Anatomy  and  Histology  in  the  Medical  School 

•  •!  Syraeuse  I  '  ni  \.-r-it  v.  N.  V.,  and  I'.  C.  SI:IM  IN,  M.l).,  Clinical  riol'e-sor  of 
I>i-"as'  s  i  if  tin-  Mind  and  N'ervoii-  System  in  thu  Colleue  of  I'hv-icians  and  Sur- 
L'e..i!>,  New  York,  ('in'  volume,  Svo,  <'"-'*••  paC'-s.  Price,  muslin,  *~>.~>(>  ;  leather, 
!*'!..  ~iO. 

'•\'>l,ook  in  the  Kn^lish  lan^nau'e  Drives  such  the  ;:re'itost  C,erman  minds.    Thehihliojrrapln 

n  thorough   ft'siimi    ui1  the  elements  of  medi-  nf  tluMvnrk  lu-fun-  n»  is  VITV  rvjilcti',  anil  t-viiK'i's 

i-i'ic.      Tin-   work.    cnntJiijiiujj  OVIT  M'VCII   ln:n-  a  rc-e.ircli  rarely  entered  into  d\   authors.    Tl;,- 

d:i:d  cl'.M-lv  pi  intrd  iiairfs.  i*  a  storehouse   nf  work   consists   of   four   putts,  (It-voted    resjier- 

earel;:ily  sifted  and  \vell-arraiiired  information  lively  to  (  leneral  Nosology,  (leneral    iMiolo^y, 

in  :i!i  depart  inents  of  patliolo^\  .     Unlike  many  (Jeneral  Pathology,   Anatomy  and  I'hysioloLiy. 

t:;\t!~iation>.     the    text     is    lucid     and    pleasant  and     J'atiioio^y    of    the     Blood."  —  1'i'ni  iixitliir 

rtvuiiM.'.  ami  tie  work  is   altogether  one  of  the  ./o*/  /•,..//  nf  M,  ,li,  •',,,,  . 

nio-i    va'iialiie   which    has    hecii    issued    in   the  "  The  work    is  on«  which  will   ani|'lv   rejiay 

Knu'is.'i  ia^^'iaue.     It  \v  ill  lie  in  valuable  to  the  jieru-al  :    iufact.no   physician   should  neglect 

-tudetit  of   pat  liolo^v.  and  should   lie  in  every  to  read  it,  niid  the  student  should  make  it  one 

|ihy-ii-i:in'»     ii!.rary.'"—  /'A//,,,/,  //,/,;,,    .]/.  ,!;,;',/  ,,f   his   most    el  cri-hcd    text-hooks.  "—  />'»//V<> 

/',,„     v  M,  .in;:!  ,,,n!  Sn  ,',j[,;i\  J,,nninl 

'Ii     is    a    liook    full    of  knowledge   for   the  "Clear  atid    cotici-e   statements,   short   and 

praetiti.  INT.       A    medical    student    could   not  simple     sentences,      pre-ent     the      condensed 

liettei    commeiico   work   than    liy   reading   this  thought     with    which     this    vohnne    is     tilled. 

)io<ik  :::!••  i,_:h.     It  has  all  t  he  modern  doctrims  This    is    as    it    should    he.      Those  who  desire 

and  di-coveries."  —  Tfn    I  'J  i)i  if.  more  than    carefully  ai  ranged   results  will  find 

"T::e  views   i:ow  held  liy  jmi^rrssivc  inves-  in  the  copious  liihliojjraphy  and  alumdant  in- 

tiu;  toi-s  i'i  this  liranch  of  medical   science  are  teicalated    references    the  sources   from  which 

_;i\i  :     in   a    marvellous   mass   of  well-arranged  t:  e  infoiiuation  has  Keen   deiived.      An    index 

;ui(i  eurefulh  digested  facts,  cmliiaciutr  all  de-  ol    authors   and   another  of  subjects  lender  in- 

j   ii';      :'      -\  pathology,  and  furnishing  minute  valua'oie    aid.      \Ve  <-oiisnicr   this   Look  as  one 

and  oe:  ;i  ill-  1  information  on  everv  siilijt'vt  per-  ol    t!'e    mist    valualile    of    the    manv    medical 

ianii"_'  to  the  uiorl'id  state  and  disease    in    all  v.  o;k~  ir.inslated  fi'oiu    (ierniau    into    l-inirlir-h. 

its   p   oteiin    forms.       U'a^ner's    systematic   ar-  1  i  -  ;<  ppiicat  ion    is   general,   I'oi   it  will  l.e  found 

i    --kill   in    classification   arc   ad-  rot  oiilv  uj  on  the  sl:e!\  es  of  the   surgeon    and 

miraMe.  part  i'-ularly  elucidating  the    l'eanni;s  phv  dci.-in.  1-ut  al-o  in  the  hands  of  the  medical 

"t    I'-iets    i;;ii.n     the    processes    of    disease."--  student,  vvhoeanrelv  upon  no  safer  and  srrer 

.  I  :,••:•;,.:  J,  ,,,,-,  ,,il  ,.;'  ,',.     \{,  ,  /  ;,  •,  ,  1  S,'n  »,<•>».  i:uide  t  i:rom;h  the  ol'iseiirity  which   surrounds 

M.    •;-.   Win.    Wood  A-  Co.   have  place  1  the  tie   causes   and    phenomena    of   disease.      The 

pro!e~-io'i  ,,)'  t  hi-  country  under  re::e\\  ed  oiili  -  niodei  n  explanation  of  '  catch  inu  cold  '  may  lie 

'_;.•)*!  i'i-  !.\    the  pve-i  \i\  -it  ion  of  thi-  intmitalMi'  situ,    as    uell    a.--    the    more  elatxnvite  theories 

v\oik.      The    tiMist    ]'opular   text-hook    in   C,er-  witii  iiL:;ird    to   fever.       Ahove  all.   it    contains 

IIKIM  v  .  -inii  !'a  .'itr.,-  pa-  -i  d  1  1  iron:;  1  1  -i\  e  lit  :m:-  \v  hat  i-  to  l.e  found  in  no   ot  her  single  volume 

in  tin'  i-ouiit  M  .  t  he  oidy  woTider  is  that  it  ha.s  -    it    i-     ti'h  d     \v  it  h     a    complete    and     com  pi  e- 

ll'i'    I  ei-n    .;M.M    to    t.!.e  profe--ioii  of    America  I.elisive   -CMC-   of    -\stematicaliv  arr;in:;ed    a!i- 

hefoi'i    this.      The  nio-r  cni-'-orv  ijlance  through  straets.  which  form  an  epit  ome  of  L.'em-!Mlpa- 

it  i.s  -nthcii'Ut  to  con\  incc  (,ne  of  the  ex<-elletice  t!io]o.;y."—   />nst<i,,       M,  i'n,il      niitl     >"/\'/e'cc' 

•  •t  the  w,.rk.  v.  i.iej]  hears  the  ini]  n  int  of  one  of  •/••-•• 


Longstrcth,  Morris,  M.D.,  etc. 

tUllj   MATISM.   COfT,    AND  Sn 

I  '  v    -  1  1  i  '-en  ]  it  Ii  '11.        See    pa  _'e   ..I. 

Bnrwcll,  Richard,  F.R.C.S 


MATISM.   COfT,    AND  Sn.Mi;  n|'  Tin:    ALL1KI)  IMSKASKS.      Si  .id    mly 

-  1  1  i  '-en    it  Ii  '11.        See       a  _'e   ..I. 


Lynian,  Henry  M.,  A.M.,  M.D., 


i'  M.M:I  ;•  ,    iii  tl.c  '.\  miicn      '•'. 

AIITTI'H   l\l.   AN.KSTHKSIA    AM)    A  N  .1>TII  I'.TK  S.      S.,!d    ..,,!  y  l.y  -ul'-cription. 


S  OF   \VILMVM   WOOD  A    m>II'\\> 
/>/*(.  <7-S(  6'    of    <>1<1   -I;/',    .tilf  <"t !•(<•;* tf. 

Index  Rerum 

I'm-  tin-  l".-c  (if  IMiv-iriaiis  an. I  otl..  i1-.          "M  "H\y  l\y  .-u!>~'-i  i[>'  :•  :i. 

Charcot,  J.  M.,  M.D., 


Till".   I>ISKASI-;s  ()]•'  OLD   A<;K.     Traii-'.ai.-.l   l>y    I..   HAKUI-ON   Hi  vi.  M   I' 
nmiu-i-ous  additions   l,v   A.  I..   LUUMI-.    M   I  >' .    .-t<-.,    I'n.tV.-oi-  ,,•    I'.vi 
I'ra.-ti.-al  .M.-dirin.    in  fin-  M.  d;.-:<:   I>.  i',.!  -in. -lit   ..f'  tin'  liiiv.-r.-i; 
N..\V  Vurk  ;    (\uiMiltiii-    I'll v>i.-i.i:i    in    M1,.-   »  haiity    H..-]'ital  ;     '.-•   >;.      !!•;• 
Out   Door  U.-ii'-!'  ;   to  tin-  Ci-utral   I  >i-]..-!isai-y  ;    YUitiii.:   l'h\>it  ian  t..  !!  ••   I: 
Hospital  ;    tu    th.-    Mount    felliai    !!• -.-]•. tal,  «  tc.,    i-tc.       Su!J    uim 


Beard.  Geo.  M,  A.M .,  M.D., 

l-VU,,\v  .,f  ti...  \,-w  Y..rk  Aoa.l.-!!i>  i.f  M-.!i. •:!!••: 

UT  ..!'  ::i.-  A:n.-r:.-:ui  N -:,!-..:,  --I.M!  A-s-r.u: .. 

Rockwell,  A.  D.,  A.M.,  M.D., 


A    I'U.V'TK'AL    TRKATISK    O\    Till-',    MKDK'AL    AND    SI'KCIi    VI.    r>K-    i>| 

TION;     I.DCAl.'l/.l]!)    AM)  i'MNTUAl.  < .  \  l.Y  AM/ATK  )\  ;    Kl.Ki 'Tl;<  »I.Y<lS 
AM)  UALVANO-CAl'TKUV.      F-'irtii  Kditimi.      lu-vi-,- 1  l.y  A.    1  >.   l;  »       •.     i  i  . 
M   l>.      On.-  vohnii.-,  ^\-n,   >^  ;.aj.-.  ..',.-  Inindri-d  a:i  1  .-: .  l.'y-;.::.--  w.-.d-.  - 
in.'.-.      I'rii'.-,  uiu.sliu,  s.'i.riu-.   h-atli'-r.  .<o."in. 

./ 


lli'i-tva1'-  1  wit  ;i  won  i  r  its  in  a  \v:iy  u  hicii  .-an-          "  \I.  .r.    iinjuirluilt  as-i-i  IIH-  •   1-1 

nut   r'-i:l  T.I  li.-  nmst  us. -ful  tu  st  ..!<  nts.  <-n  l.y  tin-  illu>t  rr,  iuu.-.  I.,  tin-   rlia; 

"Tin'   mart  -i-   of    t!i-.   vulr.Mn-.  :i;_':iin.    i-    ;..]-  i !•;<   n;  ••  i  an-ii,  %\  !:.-fr  t!i.-   va;'i. 

rnira1'!'.   an-:i;i_'.-.l  :    li.  tt--r  than  in  any  li"..k  ..('  ut'  a|>j.lyn;^r  tih-  aj.jia:  atn.-  i:    ' 

thi-  kin  I  wliii-li  I  Imvr  K  -i-ii.  t  :ii'  liitt'.-rcnt  atl'ri-Muii--  is  i-xjilaiin  i 

"  Kcf.-n-iii-.-s    ruv    ijinuri-.iiis     ami    sicc-nratc.  Jmn-niil  uj'   I/.  „ '.;'  ,s.  ,'.:,.-.. 
a'l'l    w<-    .in-    i|-  li.;';.t.'  1    'u   liavr   tint   \v:,ich  \v.-          "  1 1.  is  uiiqurst  iuiialil\  t!i.-l-    *  : 

la--k    s.i   :H  irli    i'i    filinns'  all  othi'L"  >Mi-li  )nink-.  authority  "U  this  .-irii.vt  ai  ].r. -i:. 

iri:u>-l\ .    i'uiii|il''tc    in  l.-\.-s.    l..if'i    \i-rli.il    •...'.  'l'i:..s..     \\iin    \\a:.t     1:1    ::,i>    i-."-. 

l.ilili.'jvainn.Ti!.     'I'jii-y  liavi-  ]> -rl'i- -t  ••!,    it't:..\  al>ri-a-.t     ..f    t;:.-    linns    r  ui    (.:::. 

ill  i  nut    u!  i_':na'.-.   a    in.-l  :i.  .-1    ..f  rii-i't  m  -tiit-ra-  wnn'li  \vill  1."  in.  '-t   s-f  i  -t  a." •  v.    ;.' 

].;.    wliii-h  Tili'y  rail  L,'i-lii-:-:il   I'as'a  ii/.  iti.ni.  -    /,'••>,,/ /    !/•    '.,-,••'  ./../'(-. 

"  It  i-  a  pi  -.-i^iri.:  t'. -at  in;  in  tin-   pn-si-nt  \nl-          "The  i-urnpiii-at'-.i   inr:i:i..ls   ;ii. 

nn,.'  :lvit  til.-  i  in  si  i,'  .(.s^l'ul  casi--.  ln-ai-  t  !n-ir  ju^t  t  nr.  -  that,  hav.-  dish,  ai  f.-ii".  i  t  '  .    : 

J.:.'ii  -it  in  11  tu  1:1.-  siii1  'i-s-it'ii!,  a  ii1 1   t  n  at  in  otluT  .  .|'  j>r.-\  ni!is  ant  in  .1  -  nil  Mr.  -  i.;  :r..- 

-'  i',.-.  -  \vh  •!•!•    s-;  •••.•-;-;   w.is    i :.  -n:n]>  ]•  t  ••   t  •;.  r«-  i;  i\  .-    l.rrii     [.nin.-  •  1     <>(    1 1  ••  I  •:  n- 1.'  '  •' 

i-  n"  aM--'n:i:   totiiik"   t;).-   r.-,--iIt-   in.ir.-    sati~-  :'<.in.iin^   s\  imn  \  MIS.  "      .1 

f-i.'t  ,rv  r-ian    t:i.-\    n-all,    «•••:<-."    -/,'/-,'.'.v;<    ,»••/  .  r. 
/'.,-     i'i   )[••!.     ,    <  'i,  ,'/•///•/•••/.'    /,'•  i'i'i  if.  "hi    ;ii.'   arvanu.  nifi."    "'    "' 

'•  \V>-    ran     i-.-;illy L,"M':I!II.-     Mrs.     Hai'.l  th-    pr.-.'iitat  i.iil    nt'    th.-;r    • 

:IMI|   i;.i.-kw--ll  nn  t  in-  jn-.i.lu.-t  Ion    ,.)'   ;i  v.-rv  i-\-  thr    M-..|»-     ,,('    t!n-ir     st-i.!i.> 

iii'istiv,'    work,    t  liorniu;hlv    nj.    t.i    th.-    tiin..-.  tl..Mu'h     nm  !•  --t    n.ann.  i    u     N\   . 

a  M.  I  .  vini'im'  an  intiinat  .•    taniiliarif  v  \vi;  h  1 1).  ;  h     r    o\\  n    •>  i    -.'.  -.    an  i    in    '  i.      '•    ' 

l.'i-  !     -ml  t'op-i  :!t  \vnt--r.s,  :,-il   a    h.i.i,,  .]••   .J.  -  D:-..    |!,-;ir.i    .-.      i    K 

si-'--  t  i   :-iv.-   an   !nin---t    ;ii'i'o;:nt    of    th.  ir    i-:i-.-s,  inrnt.  .1    a  -    '    i\  :•  ..    I  .•-.-:•;.. 

Ho'     111  i.'iiit'vin^     thrir    snci'i""..-s    nor    i-nni'i-a'.  a>:.i    i  n  ~!  i  n.'t  1  .  ••  \v. .:  i;    ..;i     i.,.;..    , 

r: ..'  'hi'ir  t  iilur.--.  "    -Iiit>,'in    o-/. //-,'•  ,-.'.,   ./.  .,  :,•    i    ll!;,     v\  j.j    h    ,..':!.    j.  •;;.,,;  -.      rt\ 

i|-;ii-.-ini'nl  -    of     t .,,-     l.';~\     M  ,,  •  it 

"  S  ipi.'irs   a   loiiL,'-fxistin_;  want    in  .!•-.••  i  -;.     :.-.n\  -in-',.   -,....;!,. .11  !.- 

"  \\  i-  k>  . ..'."  of  no  ot  ',i  r  work  on  t  ':'..--•:'-.••  I  i'     i    from    a     I-  •! .  I.::.    l.u;_  •,-.  '•  . 

t::  it  u'ivi's.  a-iytinn^  like  ti.c  [.r.u-ti.:al  .:.-••.  .r-  .!/•  /    •-     /,'<•.  ..//••./. 


<'»  I'lT.LirATIOXS  OF  WILLIAM  WOOD  X-  CCTMPAN'Y 

J£f(-ct/'j<'itt/.  JM((ss(t<~i(:. 


Rockwell,  A.  D.(  A.M.,  M.D.. 


LEtTI'UES  ON  ELKOTUICrTY  (DYNAMIC  AND  KUAN 'K  LINK')  IN  ITS  RE- 
LATIONS T«>  .MEDK'INE  AND  slU<;ERY.  On.-  volume,  .svo,  12?  pa-e.s, 
i',!>i:-;rated,  iiiii-'.in.  Trie,-,  si.','-"). 

1        i. iin>  al:  that  is  practical  and  useful  on  "Tln-i-    lectures  embrace  the  more  imj  or- 

nii                 '   tn    th'     pract  itii'in  r  ;   it    i.-.   concise  taut  .  praet  ical  mat  ters.  ;i-  the  inanipuiai  ioii>  ,  t' 

.-ill  '  i-  •   ••,  v-t  ::i_  !'  '    i.ad,  and    should    In'    in    til'-  apparatus,  and  t  he  fields  of  disease  when    eicv- 

hiii.    -ofe\en  practitioner."— ll>.v/(r/( /.i"(--,f.     tricin  will  pnnnis.- tin- most  y 1.  "—  <  il,^,  t,-:, • 

"  I'r.-ii-ntiniiiTs   wi-liiim   tn  clitaina   kimwl-  Vn'-ll'. 

,•  I:..    ,  |"  tin1  nii-tiiii'is  i't'  apjilviiiL;  aini   itniica-  "At  tin- olusi' <if  tlii1  Imok  llnTi1  arc  a  si-rii-s 

:                •     .    .•  _'  .  'f.-t  ;  i'-it  \   in    tin     triMl  Jt.i  lit   «\  of  pit  !iy  piiia^raphs.  <{iviiii;.  in  pl;iin  laiigua^i*, 

fii^      -                   t    liml    mutv    i.M-t'ul    inl'iiniiat  it'll  tiic  prai'tii'al  applicatinns  nf  tli>-   ilillc-rt-iit    fir- 

•  than  i--    ct'iitaiiii'd   in    thcsi-  r.'iit.-    in    \aiimis    atl'crtioiis,  a>    slin\\n    Lv    tin- 

!•  (••  .1    ~.      \Vc:  take  i>lcasuri' in  I'Diinncndin^   it,  prr-niial  i/xpi'rii'iiei.' i>f  thr  writer,  and  tlm-i- of 

t'i  i    •  ir  iit'ticu."  —  <.'>.iH'.('i'i  Juitr/i'i!  ij'  M<_  (/(../;  utiii-i     IM:::J  Ltfiit     f-i'cci;Ui.~tti." — M«li<-<il  /{••'- 

.*»  i     .   •  f.  vi'd. 


Gin  ham,  Douglas,  M.D., 


•  \V      i-iiiinni    .  i  tin-  work   in    those  who   avf  until  in>w.  will  li.-  fo'ind    in    Dr.  (Ivaiiarn'^   cv- 

HIM  •     .                •      unrits  of  friction.  kncadiiiL;.  cf!i'-ir    volume."  —  /,'•/•''///,<,/•,     .^HH,    ])f-iinlnr 

in::     ;  '  ii  ''t  ::...'.    r"lint;.    and    pci-cu.-sidii     of    tin  li.    1>S1. 

xti          .    tissues   of    the    liodv,   with    a  view  to  "Tile     -ni';.'.-t     of     tiiassa<,'e     lias    lie<-n    ono 

th            .    iti\-e.  ji.iliiative,  or  hytric'iiic  elfects."  toward  which   the  attention  of  thi'  jrolessioii 

—  I              '                    •           '^          ".'.;,:       .^    :,,-:•'.•'       J>    :,:,-.,.,'.  >      ',    ~       i                  I  I      I  I  j  I    C.  '  t  .  '  d      1                !••      a    lid      IliMtV      ,,f      hlte      \.      ill'S. 

i      ::  '.    :.     t'i     in     the    liands    of     a     ineiiicnl  Asatheiap      (  ic  mea>':rc,  it  has  ln-eii  ^rowiliij 

1:1;          '     ••;    itati'iM.  the  wi.rk  may  lie    a.  c    •  li'\    in   fa\  .>;•"--  .I/,  ./.'.,;/,(/,,/  .S(//y//,  ,,//,',- 

:   •      in   evpiainiiiLT  tins    I'e-.nscita-  t><trt<  <•.  (  )ct..ln  r  '.'n.  IN^.}. 

and    as    .1     _ruide  to   it-    pract  ic>-.  "  "Ti:-    i-    a    valnalile    [irofc<K]onal    liook    !>.r 

-/>''              '                   /  /'•  ••••'  ^  /'  ^  •/,    Deo.-mhei    IJl,  wlilcli.  and  I'oi    t,.     siiliject    to  \vlncli    it  i.-  de- 

\.t    ii.     v\i'    vent     ri'    to     ['!•..  diet     di>tiiiii,Mii>liLld 

:.,'•:••   history,    from    th.'   l.e^'iKr.inj  -t.<v   -       —'ih-    A^  .'•'..,•-,  .January  1  ,  1  1>^">. 


Morgan,  Chas.  E.,  A.B.,  M.D. 


I-:i.i:i  •1'HO-lMIVSIOLOOY    AND  TIIKII AIM'.T'TK'S  :    I'.l'IN*;    A    STI'DVOFTHE 

KI.KI  T!;h  \i.  AND  <>TII:-:K   i'ins!i-.\i,  IMIKNOMI-INA  m-'  TIIK  Mrscr. 
!.\i;  \\D  o'l'HEii  SYSTEMS  DTIMM.  HEALTH  AND  DISEASE.  INCI.TD- 

!\«,  THE  l'l!i;\n.Mi;\A  OF  THE  ELEi  TKK  AL  Elsl(i;s.      One  volume.  Svo, 

'.  '  '•  •   •    •    .   '.        '•  tt'-d  \\itli  liiie  •        s,  iniislin.      I'riee,  sii.rii). 

T '.•:    i~   a    mine  of  knowU-d^'e  to   tin  "There   i~    not  nim{  in    tin-   |-liiL;H~h  lani,'iia^i.' 

•  n        •     :i  t  he  d'']iartment  of  scieiu-'    to  •/.  ..     ,       ,.         •     it  all  approach,-^  it  as  regards  the  M-ieii- 
(t  i--  a  most  thon  i          •        tnn  nt  of  the  whule  snliject  of  elect ri- 

ive       tl'.'.tti.-e       i,u       ;  •  //     ',-,,,/    /,'.  ,'J,  (r,.(    J/;  ./('(•(//.     ,i,i,l   j'/,*,'- 

"•  '      .'.'       Ii,    Ul>.  : 


Eib.  Dr.  Wilhelm, 

•         "      vei      :v  ..f  I.. 


PUBLICATIONS  OF  WILLIAM  WOOD  \-  COMPANY.          7 


Seguin,  E.,  M.D. 

MF.DICAL    TIIFK.MOMKTRY    AND    HUMAN*    TKMrKTlATCIM:.       O:i-    v   :,;iu,  , 
Svo,    II")  ].;i -,!•>,   illustrated  with  diagram-,   mu.-liii.       I  n< •<•.  S.;.."i(i. 

"Til--   "-'abject-matter    of    this  Milimi'-    is  of  i-xiiiliitin-.;  tin.- ttMi]i'-:at:;n-  in  v:i:-io-is  d'.ivi----.. 

I'M-  hiu'de-;   irni'ort.-ii'i1'-.   and    tin-   i.rol',-v-.i,,ii    ;s  .\nioii_;   tin  —  -   :ir.-    I);-    .1    -   |.h    .I..:,.-'  i<     •  \ .  l- 

nii'l.-r   •.']•'•. it    oliii  /at  !"iis   to   its  ui.thor   for   the  low  Fever,'  win  ri-  t  h--    ti  iu(>-  r;il  in '•  is  cit«-d    1:1 

•/•  al  h      :.a-  iiialiltc,-t  -d  in  l>!  iligmu  1'  lo  our  no-  two    cases    which    t'  1 :::!;  at  •  <  l     l.it...i\     :it    l!o    , 

t  .1  •<•.      The  book  is  worthy  of  can-liil    study  liv  The    ilin-trat  ior.s.     t.  -in  j»-i  lit  in  i-     ci.ait-,     i*c.. 

«  .-ei-\     mo  iic:il    /•!  mil-lit    and    ^Tinlioii>    practi-  an- «-i«jlity-t'"iir  in  iiuinU-r.  UM!  :u  >•  \  <•:  \   liaii'l- 

l:->:n-r."—f>'tr<i;t/i'>-;>:i.'ij'.]ff/i,-in,,ii,ilSi<r-  s.nii^N   i-xcruti-il.       \V.    i-.r.li:ill\    i-oii.m' n,|    C;.- 

,','•'','/.  wyrk  t"  i'U r  ri  :nlri'h   a-  ;i   highly  v.i! ) >.i lilt  rim 

"This  ili'iorritf.    cli  t,'.-intlv  jiiiiiti-il.  ;nnl    il-  t  ri'.ntii  .11  to   tin-   st  u.!y  a-nl    i.-nlti\:it'o:i  o!  !.'..- 

l':>rr;if.-'l  Worli  i-uTit:iins    a    full    ili-sri  ;pt  ion    of  n;osl   iinjmi  tan!   ai  I  I  <  iliaL'r.o-'-  •  at'"'-:1   ;iii--i--.l- 

i-\  i  ryt  hinj:    l"  Ttaitiini;'     t"    th.-nnoiurtvy      t!.r  lationainl    i"-ivi;--ioii  .    :,ow    -i  •  dally    r!  i.i'.i- 

i-harartcr  of  tho  inr-tr  uiii-i'ts.  tin  ir  valiu-,  \isrs,  ii,^    ami    ri-w.-u-diirj    tl.i-    at'cntion    of    p!.\~i- 

rt,-.      NUMUTOUS  t.-tl-h-s  :in-  -ivL-n  from  various  i-;aii.s ."  —  r/tlirt,.-t'>iL    J/'i/iV-i!    J«, •,-,,.(! 

Ai.i'-'i'ican    and    t'lirci^ii    authui's    and    \\ritvis,  Ji'ii'i-n: 


Gregory,  George,  M.D., 


LK<"!TUKS  n\  'I' in-]  F.IM'I'TIVK  FKVKIIS  :  As  ii.nv  in  th-- C.MII^.-  .'f  D.-liv.-ry  at 
St  Thi'iiiiis'  I!o-].it:!l.  in  I.on.loii.  With  \ot--s  and  Ajipfiidix.  •  -MI  i-  -ly  in.  Mi-- 
nio>t  i-i-c.-iit  iijiinioiis  on  i-xaiitln-iiiatic  ]'atlio',o_'v,  and  ril>n  >t;iti>tiral  tal>li->a!:d 
color.- d  plat.-s,  I iy  II.  I),  lit  I.KI.KV,  ,M.I>.,  l'h\>iciall  of  thr  N.-w  V-rk  iL-j  ital  ; 
Follow  of  tin-  Now  York  Collr.;,-  of  IMiysiri.-ins  uu-l  Sur_'.-on>,  ,t,-.,  ,  t..-.  I'n..- 
vohnii.-,  Svo,  :;?',»  jia^os.  nnisliii.  1'ric,-,  ^:>.(»U. 


Wilson,  James  C.,  M.D., 


A  TIli'.ATiSi;  ON'  Tin;  rO\-I-I\ri:n  FKVI'.I^.  Witl,  an  Tiitn>dnc-io!i  l.v  J  M. 
l)\  CIXT\,  .M.I).,  I'rnfi-ssnr  of  tin-  I'ractic,-  of  Mi-dicin.-  and  Clinical  M'.-d!c::i,. 
at  tl'o  .li'lVi-rsuii  M.-dical  ('olh-i,'c  ;  Diy-ician  to  th.-  l'onn>y  I  vania  H  >-|'ital  ;  <  0:1- 
snltiii-  I 'liyMriitii  tut  In-  Children's  Ilo'<],it:il  ;  Fc'.hnv  of  l  }>'••  i  'o!ic_.'  ,-[  I'hy-:  ••;..:.-, 
1'hiladolpiiia,  Ltc.  Sold  only  1  .y  .-ub.-njri]'tion.  See  pajc  ,V». 


Murchison,  Charles,  M.D.,  LL.D.,  F.R.S., 


CLINICAL     LKCTTHF-S     o\     DISHASI'.S    <>F    Till;     LIVKK.      .lACNDICK    AND 

AP.Dn.MI.NAL    Dltol'SV.      Inclndiiu'  tii.-  Croonian    I. .-cm,.-   on    Fm    -timi:,!   It,- 

raiu'.  ni--nt<   of   tip-    l.iv.-r,    doliv.-r.-il  at   tin-    lioyal   Cull...;.'  of  I'hy-  ,-ians.      N.  \v 
i-  !  it  i1  si  jii-'-piiriiiL,'. 

'•  A  lin.'k  \v'ii'-!i  siirpussi--  in  clinic-d  useful-  thoroughly  scic-nt  illc  i".  'li>'  prinri;>lc-  .''••  w!-.!.-ii 

r..--s  ,-v.  ry  work  i.:i  iiisr;i.si->  of  the  liv.-i-  vet  it  i>  ha-.-d.  .  .  .  \\'c  coiinii.  iid  I  »r.  M;ir- 

j.u'.li-i.i- l'."  If.'/:.,,  < '!,;,•,< , -,;;,•,, i  /;,,•;,,,•.  '  chisoii's  volume  in  tlic  lm;ii. -si  t.  rms  of  j.i  ai-.,- 

"  It  i-  tin-  mo,t  instinctive,  the  m.-t  t,  ,i<-!i-  to  tin-  not  ic-  of  n-ir  i.  .-1-1.  r-  1'  i-  a  1 k  fi:ll 

('•/'•.  work  mi  its  Hill  ijt-.-t  n:  oar  1. -111^11:1^1'."  —  >'/.  of  f:;c|-,,  clearly  arid  f.ncilily  writ  I  en  ;  and  t-in- 

/.,-,',\-  )/:  ./;...,/  ,,,,,/  .s,,,.(/;,  . ,/./,,„,.,,,,'  imlvin-^  t-i,-  iat.-t  re-nits  of  -cienfifc  -ti..l 

"  A  inono'.rrai'h  on  '  Liv.-r  A  ll'-ct  ions,' which  cdinical  r.-^earch.  It  nm-,:  he".c.  t.,i  t  h  oc.-ui'y 

T:iay  '.i-  j.rotit:iMv  read  (,\  the  -.tndent  ;  and  in  n  ni^li  rank  amon_'  v.  ..ik-  of  let',  r.-nc.-  ..M  the 

which  tin-  [ihy.-iciaii  will  tii:d  a  ^y-teni  of  tliaj-  di  i  ;iio-is  ,-nni  t  r.--,!  ti,.  :,!  .•(  atl.  c;:o::.i  of  t!;-- 

nojis  hoth  practical  1:1  its  a;'i'licat;o:i  and  lisvr." — /'.'/•  /'/•." '•''  ••••/•. 


PUBLICATIONS  OF  WILLIAM  WOOD  A  COMPANY. 
/VXM/.SV.V  of  the  Jjir<r,  Practice  of  3l<  J I  chic. 
Murchison.  Charles,  M  D.,  LL.D.,  F.R.S., 


ox  rrxrnnxAL  DEUAXOEMEXTS  OF  THE  LIVER:  Beinu  tiio  Cn.unian  Lc<'t- 

llivs  delivcivil  at  tin-  Royal  (  'ullc.Uf  of.  Physicians,  i  n  .March,    1S7-1.      One  volume, 
1'Jni".   1s-  j>ai:es.  illustrated,  muslin.      Price,  Xl.7">. 

''  Tills  monograph  is    :i!l    cxc   lii-nt   cinitrilpu-  ^ivt'il    ill    tills   little    book,    tin'   reprint    nt"   the 

t  "ii  tn  medical   ht'-r.ttuie.  ;nnl   is  worthy  of  a  Croonian  lectures,  a  de:ir  and   comprehensive 

place  in    every    medical    library.  "--(.V/i»'(N«<(£i  summary    uf     the     present      state     nf     ineilieal 

/.-'it'-'t  "ml  <  >>it,  1-1,1-.  knowledge    concerning;   the    iclation    of    I'niic- 

"  There    i>   lint   a    physician    anywhere  who  tiuual   hepatic   disorder-    to    the    various   vital 

will  not  ivad  with    aviiiity  ami    profit    thisad-  processes."  —  lS<>*t<>n      M'"/i,,il     mnl     ,V///v//<  -,<l 

Inir.iMe  expnsiti  in  nt'  this  classic  and  nm-t  iin-  .l»n  I'mil  . 
Jim  t  'int  siii.ject     —  A,nt  i-ii'i/i   M,  >li,  ,*'  \\',,  U/i.         ''This    a'hniralilo    volume,    the    work    of   a 

"This  work  iloes  not  in-i  <1   special    criticism  ]>ract  it  inner  who  lias  brought  to  t  !;.-  invest  i^a- 

at  our  hamls.  t'or  its  author  i-    known  tn  be  a  tion  of  this  .subject,   all   tne    li^ht   of   mode  in 

ilistinmiishi'il    master  of  the   subject  on  which  physiological  science  will    exert   a   ilerHrd   in- 

he  has  discoursed.       His   name    has    lon^    heeu  ttueiice    on     the    minds    of    mi'dical     meii.    and 

identitled   with   careful    oii^mal    researches   in  awaken  nnev.ed  int'-rest  in   the  complaints  of 

tlii.s    J'jpartn.i  nt    of    pathology,    and    lie    has  Vikichittiv&tis."—Tht;AiHU'i<'anJ.'riti-(iliiiit<r. 

Frerichs,  Dr.  Fried.  Theod. 

A  ('I.IXK'AL  TKKATISE  OX  DISEASES  OF  THE  LIVI'.ll.  Translated  l,y 
CiiAiii.i:-  M  I  i;>  ii  i-i  >N,  M.I).  In  three  volume-..  Svo.  Illustrated  IIN-  a  fuli- 
]>a_'e  plate  and  jiinuei'oiis  wood-ciigraviiigs.  Sold  only  by  subsi.-riptioii.  Snj 


Bristowe,  John  Syer,  M.D., 

An  '  nthcrs. 
DISEASl-;s  OF  THE  IXTESTIXES  AND  rEPJTOXErM.    r.-iniirisiii-  Articles  on— 

Ent.-raL'ia.  by  .lniiN  K  n  ti  ,\  i;i  i  "\Y  \  i;i>i-:i.i.,  ,M.1>.:  Enteritis.  Ob-tructiou  ,,f  the 
ISi-wi-N.  rieeratioii  of  tin-  Howcls.  Cancerous  and  other  <li-owtlis  of  tin-  Intes- 

tines,   Dise-lse.-.  o|    the   Creetlin   and    App'-lldix    \"el  In  i  f  oi'li  i  is.    by  ,ln|:N    Nx.  i:ii     l',!;i-- 

TOWK,   .M.I).-.    Colic.  Colitis,  and   I  )y-eiitei-y,  by,  I.   \V  \  i:  i;r  KT<  IN   HI.I.HII:.   M.D.  ; 

Disea-es    ,,f    the    l!i-ctlHii    and    .  \lills,     by    T:ii>M\S    I'.l.l/./.A  I!  n    ('!   Kl.INC,     F.  U.S.   ; 

Inte-tiiial  \\'orni.s.  by  \V.  H.  It  \NSOM,  M.D.  ;  i'eritoniti-,  by  ,biii\  I{ICIIAI;I> 
W  \  i;]ii-:i.i.,  .M.I).  ;  Tnberele  of  tin-  I  'eritotieuin.  Cai  ci  iioni,-;  of  the  IVntnii.-inii, 
Ail'e.-ti.ijis  of  tin-  Abdominal  i.'  in  phat  ic  (Hand-,  and  Ascites,  by  JOHN  SYKU 
])j;[-Tnwi.,  M.D.  Sold  only  by  Mibftcriptiuu.  Sec  1'a-e  07. 

Bennett,  John  Hughes,  M.D.,  F.H.S.E., 


CLINICAL  LECTCRES  OX  THE  i'K  I\(  d  PLES  AND  1'RACTICE  OF  M  EDK'IXE. 
Fifth  American  from  tin-  Fourth  London  Edition,  With  five  hundred  and 
thirt v-soveii  illustrations  mi  \\nod.  One  volume,  Svo,  Id','','  |iaires.  Price,  nius- 
lin,  S.'I.IHI  ;  1,  atlier,  sil. ni I. 

'•  We  recnliiliiend  this  volume  with  the  i  •  e    pome    over    the   practice   ofim-'ii- 

u!:i|'ndit:.  d    pr.-ii-e   to   the   att-  •  ud    f..r    this,    more   than     for  anythn-; 

atii.n  nf  the  practitioner  and  .students.  \V,  i  U,.,  we  value  him  and  the  bonks  which  record 
ha\e  m.-t  \\ith  no  work  of  late  yars  on  tiie  hi-  vi-ws  ai.d  cas.-s.  .  .  .  Tnis  i-  a  must 
pn:  .eiph  -  <  •(  lie  -dici:  ••  mm  e  li';e'.;.  to  advai  •  '  nk.  a  ml  records  work  and  oi'i-inal 

and  i  i.-i:i  f-d  study  of  our  art."  —  M"l       '       '      v        '\  i'.  ill  .secure  for   tin-  author   a  hist- 

in, I    ',. i., I!,.  •  :,!.'.-     ri-plltation     !IS  a     phvsinln^ist 

••Wh.  n    :il k -especially  sn    lari"-    a  b,  i,  "       /,,„,/,,,„    /.„„,,/. 

a-   r>ii~    -r--aeiii'>   ;\    f.,uit'i   edition,    it    m,-iv  be          "(i  most    valuable    books    whii-h 

i     •  .    be    pretty   independent    of    r--  have       •  -      nati-d    from  the    nn-d  i.-al  pi  e^s. 

•.  i.-ws  ;,nd  i>  vi-wers.  No  o-,    d.'vot.  d    to   the    profession  will    tali   tn 

••  It  would  ''e  .scarr.-ly  too  much  to  <-ay  that  per-:-,    th-ve    lectures    and    acquaint     himself 

I«:      F'-m.-M    marks    aneia    in  the    scienci'    and  v.ithtli'    di-cn    ,  rj )'    sn    ardint     an    e\ilnfi-r 

:        -  -  nn   Ii   iii.-       To  him  us  much  as  to     in  th-- ti'-ll  of  jjicJiuinc." — -\>  .•'    Yvrk  Jv"i'iMl 

.    arc     ilm.-     ti.u     ti.an-,'es     <•!'.}!•  '/c'/o. 


ITBLK'ATIOXS  OF  WILLIAM  AVOOl)  \  (OMPAXY.  :> 


Cede  of  Medical  Ethics 

AUol'TF.n    I'.V    Till-:    A.MKRK'AX     MKIHCAl,    ASS(t(  'LVTIi  ).\.      i: 

();i..-  volume,  IJ'Jimp,  I!','  pa-i-.-s,  iiiii.-lin.      I'li.-.-,  -Id:. 


Bigelow,  Jacob,  M.D., 


I51IIKF    KXI'OSITIoX   OF  KATIoNAL   M  F.I  >M 'IX!'        TM    whi.-i,    i-    ],i-.  ;! 

I'ara.li:-.'  of  Doctors.      A  F;il Jf.      On*-    Vuluiuf,    1'Jinu,  i;:i    j. ....-,    n;:i-.::i.      I1 


Hooper's 

PHYSICIAN'S  Y  \I>F  MF.iTM  :   A  Manual  of  th-  Pnn.-i;.!. -s  an.l  !':.!  •::.-,•  ,.•'  I'l.y- 

\\\'\i  an  Outline  ppf  (J.-n.-ral  Palli..!,..  v.  Th. Talent  if.  and  I  ly.i.-:,,  .      T. •:.::.'  1M-- 

:i..n     i;.-.-]-.  .1  i,\-  Wn.i.i  AM  A  i  in  -ir-  civ.  \i.i; .  cai,-:  K.  r.i:  >  .  ,.:..i  ,i..j  , 

H  \Ki.KY.  . M.D.,  i.on.l,,  F. I.  S.      V,.!,iiii,->    I.    an.l    II.      KiuMrut.l    l.y    n  ,  -i-.  :;- 
LT.r.' i;i_>.      Si.M  unlv  1'V  >ulir-rri[>tiuii.      Sec  ]ia_v  r>'2. 

Curtis,  Edward,  A.M.,  M.D., 

MANTAl.  (»F  CHNKHAL  .MEDK  'I  \A  L  TFi  'IIXOI.Oi ;y,  J\(  T.rnTVi ;  ri?K- 
sdlll'TION  \VIMTIN<;.  OIL-  vuhuiii-,  :]-Jui.«,  :J:J-1  p:u...s  iin.-  :u'.;-'.i:i.  I1:; ••••. 
Si. (in.  \V 1's  I'.M-k.  t  Manuals 

"Tiii'  !!i':trii'  ~ysTi'!ii  i>  cxpi:iin>Ml  in  ;i  in;ui-  jiatieiu'".      It    is    \v'::at    :n;iiiv  wav.'     a:1.'!    ••.    -' 

Tier  nt  niii-i.    liu-iii    an.l   aitrartivi',  ana  will    no  ni-fil,"     >'.    L"tti.t  .\f.-,':,,r/  .],,,      ,    ',  ,l;,ii  iary. 

<l,nihf  a. inrlUh  nrifii  in  tiif  \v:iv  nf  r.'n.li-r-  !x^l. 

i:ur  t:ii~  nu-tho.l  l-'s-i  liista-teful    to  thimt-    who  "  A  v.-ry  iir.Tv.rt-int    f-atuiv    i.f    t'1  ••  \v.  •  k  's 

Irr.  .•  _'iv.-n  it  Kut  litrlf  at  tcrit  ;oii  "—Tin    \f-  •/•'-  it-t  i-lt-ar  cxt'ii^it:ini  .  •]'  r  ':..•  r-  '  \  •'..:>  »:'  :  :..•  ]•'.•  _'- 

<•./•'  /,'    "   '.'//.  I'iiila.ifii'hia.  Pa...  .Tannarv.  1  -^  !  lisli  a  pi  4  h- vane-;'  \vci_'i;f «.  aii'l  :;  r  :-  :;  >••-  t.    i!v 

"  Ti.is    lirt  !'•    manual    is  a   tersely  I'niiipOM.-d  m.-t  i  ii'al  fnriu?.  iiu\v  sn  i.t'ffti  ~i  <•:.  i::  I  !:>•:.>••  -.r 

tr.aT.i-- 1,11  thr  Mil, j-rts    rHVrn-.l  tu  almi..,  in  a     t.-xt-l ks    an.l    in-. lira!    j..  r:.  .iu-a!~."  —  7  :  • 

c'uiivfiH.-nt  ;iml  antinirifitivf  xirt 'if  way  thai  .!/•  •'•••!''    //-/••''/,    Luiiisvi'lo,    K..,,    Fc'iruui'y, 

ifiuKTs   it   a   i.ainiy    ci)ii.-crvatnr  »!'   tniic   an. I  ls?l. 

Roosa,  D.  B.  St.  John,  M.D., 


"Tin'     L.-xii-i«!i     TI;.  a  ••:]•••-     ('ir.-f    iir.il    nno-  1  .-n-  iv..  I."\;.  .  .n        A- 

fi.iir'ii    i''..'li.'~    in    Ii-i!L'tli,   l.y   twn   au.l    thr.  ,-  n.  -t  !.•  MI  ul  .   i:.  :!;•    \. 

r  ..-l.t1  <  in    li'.'railt  ii,   a'.il  i^  tliri'i'   t'oiirt  h<    of  an  who  \\-oi-,  M    )•!;...    t  .    , 

iin-h  »hirk-.      Tin-  wh.  .!'•  work    i-  u-.-l!   itmu-."—  liirMoria  TV    ..•     •:     .   i.-. 

"'l'.;i.-  i-  tin-  .-:i.al'. -t  of  Knok.-,,  aibvil  ail  i:.\-  /•  i:'. 


!'"»          PUBLIC  ATIOXS  OF  WILLIAM  WOOD  \  CO3IPAXY. 


Tidy,  Charles  Meymott,  M.D.,  F.C.S., 


LEGAL  MKDiriXE.  Volume  I.  With  two  coh> red  plates.  Contents:  Fvidenco  — 
Tli.-  Si_n>  of  Heath- Identity— The  Causes,  of  Death— The  Post  morK-m.  S<il<l 

l.y  Mll.-eription   only.       See  ]I;ILTI-  -Vi. 

LEGAL   MFIMCINF.      V,. limit-  II.      Contents:    Expectation  of  Life— Presumption  of 

I'.-a'h    and    Survivorship      11.  -at     ami     Cold      P.urns-  -  Li-aturim,'  -Kxplo-ives 

Starvation —Sex — -MoiiMroMties — ]Iennaphn>dism.  Sold  hy  sul'scription  oiilv. 
See  pa_:e  ">4. 

LEGAL  MFDICIXE  Volume  III.  Contents:  L.-itimacy  and  IVernitv— Preg- 
nancy.  Abortion — Uaji,-.  Indecent  KxjMisure  Sodomy.  l!e<i  iality  -  Live  ]',iii!i. 
Infanticide  Asj.hyxia.  I >ro\vninu — Jlancin.:,  Straiiuulation— Suil'ocation.  ,^oM 
by  -ul'.-.Tiptiou  only.  Sec  pa^'e  oij. 

Castle,  Frederick  A.,  M.D.,  New  York. 

WOOD'S  iiorsKiioLD  rrtAcTici:  OF  MF.DICIM:,  ITYOTFXF:,  AXD  STIM-FUV. 

A  I'l'aciica!  Ti-eaii>e  for  the  1'r-e  ot'  l-'amilie.-,  Travellers.  Seamen.  Miners,  and 
cthei's.  P.y  \'ai'ioiis  Anthni>.  In  two  voliiines.  royal  Svo.  MM  and  !)-}'J  panes, 
illustrated  l>v  >i  x  hiuidn-d  and  thirtv-iive  line  ivood-fiiuraviims.  I'rio',  per  vol- 
ume, muslin,  $.").OH  ;  leather,  Sd.OU  ;  lialf  morocco,  .x7. ,")().  Sold  hv  sul'scrip- 
tion  only. 

Ziemssen,  H.  Von,  M.D.,  Munich. 

CYCl.nP.F.IHA  OF  T1IF.  PI1ACTICK  ( >F  MEDICIXE.  By  Various  Authors.  Coin- 
]'l.-te  in  twenty  volumes,  royal  Svo.  Price  -p.-r  volume,  in  muslin,  So. (id  :  in 
l.-atlu-r,  $(J.(.IO  ;  in  halt  niorocco,  ^i.ol).  Sold  by  sul>scrij>tion  only.  See  pace 

6 :. 
Peabody,  George  L.,  M.D.,  New  York. 

Sl.TPLK.MKXT  To  XIKMSSKX'S  CYOl.OP.KDTA  OF  TITF  PKATTICF,  OF  MKD- 
I<'IXIv  P>y  Various  Authors.  In  one  royal  svo  volume,  S 1  1  ]%!_'.•>.  hoiind  to 
corresj'ond.  Price,  in  cloth.  Sli.(H)  ;  in  leal  her,  -<T.IH);  in  hall'  morocco,  !<S.(ni; 
a!.-o  exti-a  muslin  not  corres])C)iidim:!,  sCi.llli  ;  and  in  red  leather,  sr.lilt, 

^  -  '•"  Tl.r  aim  of  \\\\-.  \\  ork  i-;  t"  t:ik>-  up  <-ach  ^nhjrcr  1  reati'i!  of  in  Zicnissi  n's  ( 'yclop.-ruia, 
and  tn  l.rinu'  it  do\\-n  TO  date.  Mirny  of  the  articles  will,  therefore,  cinliracc  the  pi'o^r.-s  of 
t:v  \.-ar-.  I  ut  some.  n-latm_r  to  th>-  lati-r  volinncs  of  ZicmsM-n.  lie-in  at  a  more  ivccnt  p'-riod  ; 
tic  vhnli-.  iiowever.  forni^  a  complfti-  1'i^unie'  of  thu  proi,rn-ss  of  medicine  mostlv  for  the  p>a>t 
ti\c  years. 

Carpenter,  Wesley  M  ,  M.D., 

,\--:-;'i!.'   I'.n'-, ..'..    '-•!•.  I1.,  u.'v:,    H  ,  -t.:r:»;  :    In-inirt,,r  in  tin    I'.u  li  •'.•  ••-.'' .~-.\\  T.:il>.  .-:il .  >ry  "f  t )..-  Tir  v.  r-ity 
.  •   •••  ..  i   ;;  .   .  i   N.  -,v    Y.  rk       >.-ei-.-t.iry  "I   It;.    Mc'.li'-.i!  Sncii-t>   nf  tin-  (.'oniiiy  uf   .N.'W  Y..rk  .    Secicuu'y 
111-  N.  :    Y.T'K   i'.ch,.;  ,/.    n     -    <    .'•!;.,  -•••. 

AX   INDF.X   (>F  'I'lli:    PPt.\<.TICE    OF    31 FDK  'IXK.       Sold    only    l,y    subsorijitinn. 


Flint,  Austin,  M.D. 

ro.MPKXDIT.M  OF  I'KIK  KSSloX  AXD  ATSrl   I.TATTOX   AXD   O]'   Till'    IMIYS- 
['  Al.    DIAi.XosiS   OF    DISKASFS   AFFF,<TIX<i    Till;    LUX(J    AM)   IlKAUT. 

On.-  volume.    iNii".  -1:1  pa_-os,  muslin.      Price,  ."id  cents. 

Paul,  Dr.  Constantino, 

Prof.--   V  A.T  •-'     ii.  rhi.  Ka'-ti'ty  .••  Me.ii.';nc  "f  I'.-iri-.  .  t<\ 

D1ACXOSIS   AXD   lHSI-;\sr:<   o]1    Till'.     HI:AI:T.       Tllu-trat.-d    l.y    num.-rons   fhi'; 
\\-o,...l-eii'_ra\  in_'-        So;  i  only  l.y  sul.-criptioli.       S.-e  pa  :.•  r,l. 


PUBLICATIONS  OF  WILLIAM  \vnnn  \  COMPANY.        11 


Loomis,  Alfred  L.,  M.D.,  LL.D., 


A   'IT.  N'T  T.I  M  >K    (»T   I'liACTK'AI.   MKIMMNT:.     On-  liaM.l-.'in..  -vo  v. .'-..... 
1 .  inn  ;M_-,-,  iilu-trat'-il  l>y  two  li!i:i<liv<  I  un<l  c!.-veii  en.Tav  ii;---.      1'r..  •  ,  :.. 
S'i.nn  .    I-  atln-r,   S?.IMJ. 

"'I':,,    v.-.  rk  ).,-fore  us  is  a  cornpl.-te  rompre-  wit  h  ev:  !enr,-s  of  K-n-h  unu-iia!    ii-,-- .  • ;.... 

h.  >.-.s.     f.'-atis.-    1,11     £i-!icral     pathology    an<l  skill  a»  t..  pii'-.-nt  t:i.-  -i;l.  .  ,-r  1-1  -,  fi.--:.  !u:.', 

p-       •   |.,1     i:;-"Iicir.e.       Thi-     :irr:i:i.:<-:n.  lit.     aii'l  :i:i  I  t'  ..-•!.  -1  i'  ','•     .1   in..-'    :i.-.-.  ptni.'. 

ei  i--i''e  lion  i>  that  which  the  author   ha. s  oi.-  t"    in.  .  heal    lit'  :ati;r,  .      'J'ni     i!l-i-r :  .it :.  i.-    ..:  • 

s.  ;••,.    ;  -,-,  ti'a'-;.'.ii_r.  an>l    islia-i-'l   "ii    ;i.  i  \  a::,  e-I  aor.Tiilai.r.     ori.'ii.al.     ;inl.    a-     a     I'll--.     i:>a"!v 

r,-  .,.._-. -ai  kno.vl  ,U,.."  —  /..0,/w,",     J/,. /,.,,/  .irawn.  :,:i,l    w,-:l    illu-t.at--   t:>     I. -XT     u.  «:.- 

A       -.   ,\,,\ •  iniii  i  '."^.  l^^t.  ih"  sul.jrc's  an-  ili.-M-u-.-.'.i    in    [:;••    li_:.r  ,i'-:.-- 

••  A  ."ir'-fu!  fxaiiiiiiatiuii  uf  thi- hodk  iTi-iiti-s  n;<i>t    r.-c.-nt    a.i.liti'.i.s    t,.   .,1:1     kn..u!<    i-jf.-    >.;' 

T.'    •:•.. !•!•.-•-!  'ii    rhat  it  i<  ih.'  v.mk  of  our  \\  ho  j.atii..!.  ^y  an  I   t  :.••!  .it  •    .t ,.--."      /'-1       /' 

.;»  ak-.'tii.,t    wlii.-h     !:<•    hii;i.-.'!f  klu.w-.       It    is     \,l.-.,    \f  '.'      ,'    T 'l  >,-,•,  -n.l,.  r  U'T.    >-i. 

i,  it.  a^  is  t  ,o   of'fii   Tlii-   ra-'-  in   s  u-!i  works,  a  "  [  •  is  an  rlal».!at"  \v..;  k  ><:  i , !  i"j  j,a_',-~.  \v.''i 

i:,--:.- 1',  van. j'iiij  "f  statrin.7its  which  ha\f  lirrii  ii  fuil  imli-x,  :ii-il    is    is~ii.-,l    in    tin-   ;nM:-!i,:'s 

ji    i;i-t,  :-,-i-  1  Th:oii,;:i    a  loii_;  s,-ri,-s    of  1 1  ,-at  i>-s  !,r-t    -lyl,-        Ii     ii:':^'     1,.-    iat.,1    a-    .•:,,     ..I     !:•• 

i  !.   •  L,     |  •:  a."  !•••'   "t'    jiii-.lii'iiu'." — .}[<  ili<-'i.l.    .I'i',  staii'iar.l  works  dii  t  (:.•   tin- .rv  airi  juMftio'   ol' 

I  >•  •        !.(>••;. i1..  r '.'.").    !~-^4  ni.-.lii'in.-  in    t:ii>    country,  a::.!    .-;.,,;.'!   l.avi    a 

"Ti.t    \\,ik    1 1  ,i\  I'l'-i-s    tin' usual    tirlil  of   in-  |irrfi-ri-iir>'  IIVIT  tim~t;  I'liiaiiiitiiii;  finiii  !'jir.,j.i-, 

?•  :•    a.     i, alii  'i'>.;v     c.iiisiii.-r.'.l     in     ti-xt.-lio.iks  .  \  >  n  n  i>    i-.iit.-.l  in  tin-  coiiiit  i  \   " — 1':,     '!'',•  r- 

r;,   :     t':;'     p-.u-ti  <_•  of  nn-iUcine  ;    lr.it  itdors.su  u/  •»>'••  (•''!.:>  tt< ,  No\  csnli.  r,   l^^l. 


L!JTT-RK>  oN    DISKA^KS    OF  Till'  1IKS1M  HATi  >UY   oRflAXS,    Hl-AKT   AND 
!\H)\i;VS.      (>:,  •    v.-hiiiu-,    Syn,    .V.U     i':i'.'.  .s.      J'ri.-.',    mn-,;:i.    S.'I.IMI;     1.  ati..  r, 

§11. 1  HI. 

"I-   :-.•!.  ar  in  -tyli-.  cr.nv.  niriit   in  arrnngi:-         ''  \\".>   I,avf>   r.>   h.-itation  in  t-v -.;;  •!::_•   :• 

I:..-:.',  v.-r.   i!--tiii!t'-  an.l    ].;  a'-1  ica!  in   itsti-ach-  on.'    of    iiiucii    vain,     to     tin1     \*\  •>:  r--  i  •:..    ;'....! 

ii   -       -I'",:'.,,!.  ',,',;  ,  .If../;.,,.'   T.,,, ,,.  la-lily  ..iv.lital.k-   to    the  aiul:.,:-."  — A- •      )'.  ,  • 

••  Wi- Ilk'- the   .-\st.-iiiatic   iiii-tho.l   in  whicii  M, ,;,,.,'  .!,,,. ,,,,,/. 

*':•-•    !'  I-T  ,;i-i--  ;i;-i-    aiTai:;_ri-'l.   an.l    n  4:111!    lln-ni  "  \VhiV  tin-    \  irw.s  JMVSI '.it.'.l  arc    ful!\    i;;,;i 

;.-  i-X'-' HI-HI  in   ..'Very  way." — <_'; ,«  '•  ,••  ,-<it '>    /.»/,-  \\hat     is     ac!':all\'     kiiou;:      on     ihe     .-;;t-:,r;^ 

.-'      ••   ••'   "'•>-  •••••/'.  t:,  -ii'i-il.  tin-  iloct:  -iiu-s    ai.-    ;;:.l;ri,  .i;~    a:..i    -a!-. 

"h.  ;.     I;L.    '.i-t'iifi-  v.s    tli>-    r.  -til'-r   may  look  Atth'    ~a!ii.'  t  inn-  t  h.-y  ar.-   j.;-.  -•n;     i\\i'.:-.:i 

i    :.":.!•!'*!;.   for  T!ii-  last  wor^ls   mi  tin-    su'.j.  -ct,  usual    c!.   nn.  --,  an.i    v.nh    -.i;tt:ci,-:>  •     ;•.  --ti-..- 

!»\  i     ::.a\    iv-t    :i-~'ir.-'l    that    what    tin-    author  ni-ss   to   connnan.i   con!;,  |.-nc.  . "  —  A-    '   "•• 

1:    -:..-!.    i-    !!.:..irt-.|    to  ti,.-    pros  is  tin-   l«--iilt  .I/../.'.,'.'  "//  /  >-  ,.;.',  ,•'./,..  ,-•,,,:. 

of   i  .      :.  !.-.i'  :ii:i_r.   soiiii-l    ',uil_'in--ht.  an.l  thor-  "  l!y  all  luran-.  l<i.y  l,oi  .:ni-'  \vi  -rk  ana  -'•  •  'y 


•  \\".    ha  v.    I.,  for.-  us,  thi-ri-fniv,  a    '.ook  con-  i-!ra*ion   of   <in_'--.      It   i-  a  ] k  t ;,:. :  v.  .1!  w.  '1 

\i'ij  -i;r.  nn-:i- •  uf   pract  iivil    la. -is    relating  n-;,ay  can-f  i:l  stu-h  . "   -H'.  .'.  •• 

'.  r    ::.'.  'no  i,-  o:' origin,  aii'l  ],r.,pa^ation.  ainl  will  he  iis.'ful  an  i  ai-c.-j  t./in.    <•    ',,-;..    -•.- 

-,    a-   t  .  IN-  .M-i'v  '-omp!cli.-n.i.-.i  i|.  nt     ami    !•:  ac:  '•.:  io:.,-i ."_  \         }  '..'    ' 

•  ..-  ;::  '  -••!  l.-nt.      W.   a[,  .  lu-li.-v.    they  ./'-/•- 

i-      i  \\it.ioii!     -,',,-  i:  in-  -•,    l.y    the    'la.lv  "  1  n  1  i!  is  i  t.t.'i-.'-t  in^' vo!-:ni".  u  h:  'ii  r..::t  ail.  ^ 

I;   cciiir.iin-  iniich  jirac  t:.,-  Ii-ctuics   ••:.    f.-\.  is   •!•  ii1..  ''•    i    '  '.    I'i.  '-•  — r 

.. -V!.-.i,[  ..ttion  ,,('  !  ii,-  in.-.lieal    prof.  ~  ha\  i-  a  e.  :  i-i-e  :i".I  i!iij>:ir' 1.1     l  •  -.  i.  «   .  •!   t  ii-     i:'- 

i    .-.::•>.     stat'-:i.e'.!    .  !    ta  -I-      u  it  h  i  r.i*  ur.    i-<.iie.  i  ni:  ^  |.-\  •  i  s  «     i    '       .  -  I     •  '.  ;     ' 

i'.      .'.  -  *  -,o  ; '     .  •  rl'iiij.  i  in  _'    p.-r-.pieiu(  \  o!  i-  r    1  ii"  -k-.    '  !  -   i-a  .-.     t '.-  v   .-   •:•  -i"!    '.:    (.::'_,    ••'. 

]]}•_:    )Vv.  r-  '       l-i  t  :  i-  a-  ••   >  iiil'-ii  i:-    i    1  :..•  :  -  -',1's 

-T-V  ,"'•;   of    p.  ,,f,. --or   Li  M, in  is'  is  a  of    t  ::i-   a-'th  ,r's    ,  I-.M.    .  \t    r.-Hi-   .       .:,•.!    •  \:  r- 

•.•-.-:'•      '  ion     to    :u-  -l|."i!    ir  •  i  at  'i ' .-.  r  .'-in  •-,  \\  nii-ii  n.-is  1.    i  ;:i  n,  ;..;..',::.    . . :  ::>..  i.  -  -.  :i 

•  •  •     '-•.,'.•'.:'•.    ,-u:  j.-."   i  >    t-,.i"i  i  \ •  prai  t ;  -  .-.  r'  !'n    r.-.-i.<-e*  -    a  '     \  -n  i  .::••••    w  it  !i     •:..-.     ,  ,\ 

:i';    .  i  -  i :.   -:  •  i  ••   ,•..••  |,  i  nut  -,-  with  wirit    I  !]••  -otm   oM:>T  i  ii.-<T>  •  i  -  :    a:1  i   '     ••  '•'.     .k   p-  :',t-     -I 

:     ...i-    !;:!.->      l'    oli-  l  \.  '1    a!    1  in-    l<i-.  Is  iile.  t  ' i  ••  -  ar.  i  in  .  •  e  -  •  -t   pi   . .  I   e     -A  In         !..v. ,  •    i.i.t, 

,  i  _  •  •  1 1 .  • ;  1 1   . .  f  f  •  \  .  r    i  -   i  • :  - 1  i  -,    : .  s :    . .  i  '  : ,     ••  - 1      ,'!::-.      •  i  -  • 


]%2  Pi  I'.LICATTONS  OF   NYILLTAM  WOOD  &  COMPANY. 

7>/>v  </.v,  x  of   Throat  <tn<l   Cluxt,  of  tin    Juct 
Corson,  John  W.,  M.D., 


Ingals,  E.  Fletcher,  A.M.,  M.D., 


I.KI -ITI;KS  ox  THK  DIAGNOSIS  AND  TRKATMKNT  OF  DISKASKS  OF  THK 

CllKST.  THIJOAT,  AM)   NASAL  CAVITIKS.      \Viih   en,,   lnm.lr.-.l   and   tliirty- 

liv     ilhiMrations.      One  volume,  Svo,  4:'>7  jiare.-,  luu.-lin.      1'iiee,  S-1.UO. 

"In  briiniini:  within  one  pair  of  book  covers  student  ainl  practitioner,   in   the  -ti;  ly  ..f  its 

a    c   ii.-i-t'   epitome  of   affections   of   the   chest  snli|ect.      It.  is  clear  and  conei-e  in  st\!e,  s\ -- 

•    .    ,  !,in-.-  iv-piratory  tract,  Dr.  In<;al.- has    tematic   and  th iirli   in   the  coii-idcrat  ion  of 

/.,    :    ui,'    int.  r.l,-].rn.I.'.,t   jvlations  of  a  «-:n-h    >h-iMl."—f/,ini;/-i    .)/-  -i',,  ,,l  .!,,,,,  „„!„,„,• 

^iciiiji    nt'  a'.;it"inn','il    rr^ions    falling  to^rtln-r  /:'j'>i>tilin  r. 

i!-it:;r:i!lv.    Imiii    in    hi-t < lioLry    aii'l   jiatlioin^y.  '•  Both  a.->  to  the  matter  anil  arraiiirt'in'-nt  of 

]  1 ;~  \  i  >!i ; nil-  aims  I  i:rivhy  at  an  oljjn't  ivi-  coin  t  lie  Imok,  it  niu>t  '"•  o.t  j^real   ser\  itv  t<>  tin-  <ir- 

:  !i  ti  :  '  -,-i  '.'•  liicii  ha-  nut  hithei-to  liccn  attain'''!,  ilinarv  j'liy simian   MS  well  as  to  t  he  sp-ciaiiM." 

tui     •     .-     wli'ilijc,  i'i  any  single  work  of  jiiiy>i  -I  ir;/i>ii'i   .\fiiHi-nl    !A. /<,'//.'//. 

c.il    ilia^no-i-i,  or   on    any  disease  of   the   cliest  "  Tin;  work  is  of  the   most  prai'tical  eharae- 

and  air- i.assa-cs."—.!,m /•/.•<(><    Journal  »f  th,  ter  ;    i;  avoids  theoretical   and   i,  n-et  il.'d  -r,e-  - 

s (ions;     the    subjects    aiv   ple.-elited    in    a    1'ieiil 

"  l-'nr  L'ood.  practical,  and  correct  teachnur.  and  compact  .-tyle.      \\'e  piediet   !'..r  t!i:-  '.vo|-n 

I!       -;,i-,.r       There  is  110  Volume  a  wide  licld  of     u.-el'illl;ess    lieeanse    it    >eiT.i-'.| 

would    lie    nioie    usi'l'i;]    in    the    general  us  t  n  I  ^e  exactly  ada|ited  tu  1  he  H-e  of  The  p!i\ 

:         titioiier'n   daii\-  li  t'e.  "  — .  I  //<•  ri'-nn  Jf-'/ifi!  ,-ieian  in  act  ive  prat  t.ec.  "— .  I/.  ir>/''ii'-l  M«.i  •  • 

II           ,  Journal. 
"This    I'unns  a  valuaMe.   aid,    but'.i    to    the 


Kclscy,  Charles  D.,  M.D., 


Till:  l'ATIloI,o(iV,  lil.\<;  \osis.  AM)  TItKATMI'.NT  OF  DISKASKS  i)F  Tin: 
III'."  I'I  M  AM)  AM's.  One  volniu.-.  NVO,  |:;d  pa:.-.  iUu-trat.  1  liy  t\vo 
i  hr-iii  iili"  npiiie  plates  and  inan\  v l-i-nuravinirs.  I'ricr.  in  cloth,  ^•l.(!i>. 

"  Th"  aiin  of  tli                            IH  --it.    make  "  !•  fonnsthc  l».  -t  re  -enl  uo,k  on  a  ,  lass  of 

this  I !:  ;t  s-,f.    _MI                   i      tiident  and     >    .  din    se    ,vlii.     ,    althonuh    claim,  d    I.y    sni-.-rv. 

or  :.l  pr.e't  iti'  n.'r.  aii'l  to  fni-ni-h  t  hat  int'ornn  ha-    more    im  dical    r.1 1, -it  ion    than  n.o-t    ph\  -i- 

.   me!:    i-    -o   ilith'cult    to    olitaiu     with    ul  i;i        in   awiue."-     '/''<'    '"..,'/. ,/.,/,,./'"/;,,,,   /;,    . 

:tdvanta,'.'S,    such    ns   arc    ol.taimd    liy  ",-,/. 

cla.ii--,  .te."  "  The  \vork  is  ;ui  excellent    oi-e.  and  will   !>»• 

'•  In  ,     nclii-i-in.  «•••  will  add  •       -  appi    -  :  it.  d."      77,.      /'/,//,/.  ;.,„..• 

ha-  -nee,  ,  d.  d    adiuiraliU   in    -i\ii  '                •'   /„>>, .,t!:;, .?,,,: 

will  u'f'-atlv  advance  tin- domain  df  ri-e  Th,       tinleiit     and    lni-y    pract  it  i<  .n.-r    :\\]] 

•  v.  and  eneonra^'e  leans  a  praet  it  ion.  r  liml  i;.  re  in   a  condensed  f,,i  m  all    t  hat   i-  ]  o-i- 

-  heieTofoi-e  -!;n:nk  f'oi ,1  tin-  disi  ,-(,..  tivi.-ly  known,  and    much    that    ha-    not  he''ore 
Pii    and    uni-ati-1'act..ry  l.rain-h    of    sin::.-].,     to  .         .       nl,  d,  cone    rnin^  di-easi  s   of  t!:,'    ;-e,-- 

•  a_-a:n     \vitli    'r-i:eweil     contidellCc."—      t  ••-.  a  i.  1  a-  i:  -."---/'/,<    ,]f,  d'vil.     /;/<''.  M/'.   1'lii]- 
A      '     '     ,•      -,./  M,-r,<-al  .I,,,,,,-, ,<il.  ad,  >!  ia,  1'a. 


DISI:\-I:S  <T  THI:  HKITC.M   AND  AXTS.    s  •!  \  o:.!\-  i .-.-  -iii.-eri, .•: -,:,.    <,>. 


I'lTuMCATlONS  OF   \YILLIAM  Wool)  A   COMPANY.  1:5 

!>/'*, /is,  .v   nf  tfn-   J'iirfnin   <///</  .!////••>•,    77"  1'iij" 

Bodenhamcr,  William,  M.D., 


TKL'ATIM:  o\  'run  IIKMOUKIIOIDAL  DISKASK.    civi-i 

('..•;-•'.  |':ttli"!n_'v,  l)i:i>_r:iii>i>.  an  1  Tivatnifiit.       <>!n-  vn!niii'- 

;'.!•;-•]•.  i'i  ••!  Lv  t\vu  rhr»iu"-!i:  !i.'_  raj'hi'-  j'laU-s  aii.l  many  w 


iiAiTicAL  TI;I:ATI>I:  o\  Tin:  .I:TIOT.OI;Y,  PATHOLOGY.  ANI>  TIM:\T- 
MK.NT  <»r  Tin:  CONGENITAL    .MAI. FORMATIONS   or   Tin:    KIJ  TIM 


i'KA«'TifAL  or,s!-:i:vATio\s  ox  Tin:  .i:TioLO(;y,  PATIIOI.IH.V. 

SI-N.    AM)  TI;I:AT.\II:\T  oi'   ANAL    n^si'itr.     r.ii^nai-.i  \<:-  -..'n^-i-..-, 

!-.;-•-;,.  it   -{in::  ii;_>.        (  >n.-   vnluilli1.  S\-<i.    !  I1'.1   {•  ••  -  •  -.    liril-lill.         I'li.'t'.    S'J.'.'"i 

'   T:.-     t:1.  ati'-i-   i>    r'.V"  i_-h,,;;t   (-:,:vt:;i!y   ]n<-  st"  •>•:  il"  ir-.  \VM.-M  t  M  a*-- 1  i:>.  :<  ~.  i.;ir.i''   v.  ib: -.:•• 

....i.    ii:  i    \\--    r- I't.'.in::--!!  I    ii     :i^    a    valuaiili-.  u  <•  >^,-t  t  In.-  Mibjirt  in   an  i-xini'  l--'i   a;i'l  iniuul 

k.  u.'i!  i    •  :!••  (.la.-.'   in    a!n   \vurk-  I'nnu." — v.   /.""•'«   .\f"in"!  j\'- ,.'<••,,•. 
-I.'.'     .'.,'../   s-  .•.•.,/..,'  /.'."  ,,.-,•>,/•.          ••  It  v.-il]  I,,-  j,,  •ni-,.,|  \VMI.   ;jit.  P--T  aii'i  ['i-.iii' 

•    'I'..:-  'i-  '!..-    :.    ,-•    r-;i, !>!.•!.•   airl   rx'trns:  v  l.y  all. "  —  ] t,  t ,;•<>  /,'•  ,•,,••,.''    If.   / 
•.•.-    •  •.   t:.:~    •.  •  rv  painri  1   aii'i   iniiiMi-oMii-         "  U'c    ln-lii-v   tiiaMln'   -uli-i.-T    i.;,-   p-.-.'iv.  . 


Ringer.  Sidney,  M.D., 


'!     i  '-.  -   ul'  liir-  i:i'ii!f>  r!i;it  \vr  --a::']-,!    \,i;i;,     :V 

•'i-'    •.'•••    1    I   i    :!-•     i  i   Iirirli    lai'jrr  I  i,i  i  :,p  -u:  i.--.       I  • 

':':.•:.•!:'     ilisca-'  -v       >..•:><•!'  wit  ;i    n: T.-I'I--:    ;.!, 

'.  •!•••!•  r.. nun.  n. I'  'i  MI  .-I  run  :!.,  v.'ill  '.••   !.••;;..!  •    .   i 

'.        :.    I  ;  ••    i   t..  ..iv    I'H  ".    •:    t  :•;  r.  ":-:  .•  1  y    I ',        ;,:  -,    f ,  •   . . 

!'•  •!      !:.:.      V     :     -i-   ,),.-•.     I'i      "ll:  I  ill  i^I'   1     ,1>  i-     ,  .      ,••.;',    i .  I    t  !,• 

.l',<lr.  M      I1V-T     l,:i.\i'ir.|     I..  .  ;i  i  ,  -  •,•':,  :,  ,-..  ....      , 

-  i  •  :^l.i.''  •••.•^  .  ";v  ii.  i-iT  ii  ,;i    in  fiii.ti  'i-t  ii  .n  r.  ,M      t    \.  i..    .,o 

tli..-    N.JV.     ^'l.:K    J  )l-.|"'U>;irv   all'. :;  .ii..  i   in-  l.-ii<::i. 


1  i  I'tT.LICATIONS  OF  WILLIAM  WOOD  &  COMPANY. 

M<it<  rid  M«licn,    Tin  ra] 
Fothcrgill,  J.  Milner,  M.D., 


iNiM'.r.snnv   i;n.it»rsNi-:ss.    AND  cm T    ix   ITS    IM;<>TI:AX    ASI-IJ T<. 

I',!-!   1        I  ;idi_.  ~:io:t   a:id    Mi!idii-!iess.      (.'no    vnluni'-,   1'Jni".    ;!'Ji)   i>;u>  -.  in;;.-i;n. 

1    T       ]'..••.'•.     if    li      -tion  to  Imliits  (ifl'ifi-,  four  chapters  aiv  duvdted  to  it"   functions  ai.d 

.;.  and  t<"  the  perfect    niitrt-  their    di.-turtiatices.      lit    n  t'errin:;'    in    ti.'1    in- 

!;..;:    ,  ,|'    ti;.     Kodv,    a:e   t:.  •••••!    it!    ;i    i-ia-i.rh  Iliirluv  uf  mental  xt  ruin    ami  \\orrv.   Dr.    l-'-:h- 

m-im;er,  and  .i!iomid    \;\    ]ua.-t  ical  hints  oftiie  IT. rill    s:iys :    'Talkm.:    one   il.-iy    with    Mi     \\-.\\ 

^.T'-att  -t  I •••- -!!'!••  i;ulii  v  in  the  p-.u-t  IMII:;  pli.v-  Alilmtt.  wlmsr  litMviil  -  l'nr  iiial»-nc.;  h;i\i-  -licit 

Mr,  :IM.       Al!"L,i-thi  r.   tli'-wnik    .~:i   1 '  :u:i :  k;i !  .1  y  a    wi  l!-<I.'>i  rv<  1 1    ivi'.nw  i:.    I    a-ki.l    iiini.   "\Vi.o 

<.•'•-[".;•  !••• ':. !-i: ^i  \  •   -•  ;i'lv  i>f   i  -    •    •    '  '.vlm-h  i<  tmi  :irc  yc-ir   dinli.'tirs   must  ly  V  '       '!'!:'•   '.'•  {'ly  \v;i- 

II:T!>-    i:r.  i«T-t",  -1    l>v  T  •••    nriin!  ity  nf   i:it.-<llral  \>-ry    siu'iiitican  t.       "  H  •;(-iiH'->i    ii.''ii.    1-1  Ti.pa;  ;i- 

!:•••::."       \          )'     •'     I/./'      -'   /,'.    •••••/.  tivflv  c.l-l  ;iii(l  '_'r:iy  fur   tlnir   yi-:ir- ;    iiii-n  '.v!).i 

••  1  >:.  ]•'••'!].  :•.:!.-                       Kv:iys  cmiuniiinl  l.',,ka-,    :)'   tln-\    hail  :i   d.-al   1.11    lici:    niitnU.'' 

;  •  •                                   I                             ami    rl!    i't'    in-  Tills  was  tile    iv,-i|«in-*'.       I'    >t.ii;.l-    ii:    -':u^'' •>- 

farfs.    dr.iwi    !iin«.tly  fmrn    his    n\vn  tivi-  n.-liitiditsliip  to  t!^  fact    (»)' ;irntf   'ti;il'i-!is 

•••          '•        Tlii-i     viiliimc     i-     wiiit.-n  \>.  in:;-  si-t  up  by  slioc'k  or  other  nit'iilal    ]MT'::r- 

f:   '•!!    ,                                   I         ••••lit,   and    K".1  n  i  >  li-it  ic  in.  ur   df   its    artificial    jirndiu1!  i»i)    i  >\   'he 

\   .'   .       .  ;ic  I'tiMt    >'f  natur.'il   (liL'^stinTi,  l>y   w;iv  puncture  ot  the   fldorot'  the    I'mirTh   vi-l!t  i  iele. ' 

.•    ••!     :    ••  .  •    di- ;i!iti'lif>is  tn  the  Titiiiu  tdj.'n:  Tlie  \\ln.le   )v;uk   is  pi-;.ctii;;il   and   iiimv-'.iii:; 

\     ill       ivi  i1    is  t!ie    _r''at    store-  )va  ii;i_'." 
i    •    -•    ii)    -':;':'-    for    the    use   of    tit-    system,  • 

Phillips.  Charles  D.  F.,  M.D.,  F.R.C.S.E., 


Garrod,  Alfred  Baring,  M.D.,  F.R.S., 


:  re    ;i    lui,  f    ,• ,  ;'    :..:,:.  ,  .:t 

••If  li;i]   pai  (s  !i.-ii,_-       :,.;-TI  •!. 

•      •'     :•        ln>-  I  I                                  .'.    -1  a  Cdllill.elltar)    r-n   t  i.o  I'i,:,y- 

•  :       •                             '                       '     W"tk  t  .                                     -.innc-whril   n—'  in'il"  -    I'i.i'lii  -' 

•  '              '             '                                    I  : '    •  >' '  mi    I  lie    1,,  .11  ion     1'liai  III;M-.  •!    i  !'i, 
'   '  '                                             '                     :     '       "  I          jh  mm      <  \\'  ndi-d  in  it  -  di  sei  ij.t  jdi.  i.;   t  "."• 

'.-.    :'     '                                                        mother    i  ill   and   uses  of  I't-iiii  dl-'h."  —  /:'<<'•'''<       '•!•   •   - 

'•    ;    for.'         '                               -  -    ,/  .<u-n.il. 

Trousseau.  A.,  M.D., 

•  .  .  '  :    •  '• .  •  '•  '  ••   f  -  (ho  ril't."  Pio:;,  •  •••  .    •• 

Till:!;  \1M-'.I    !'1<  <.  '   ,    l>    I'.   I.IM  m  \.   M   I).,  fv   in    •' ...    Mat-rin   M.-li'-a 

:  i:ii::-  M.  i  i    .   !i(.-d.      V..!.i!,i-  I.I!. 

;•        '  Tr      --•  'in  T'.  •  '!  ,        :      '-i.f.  ss:-n  -  !:;-  t.'-'.f.'M.d 

;    .    '    .  a    - 1   l.i  -    d'-Ii::i,!  T.i  -l  \  !•     n-ii.ii;.  i:d 

•      i        Tiii  -  u.  1 1.  i  -    -aid  '..  In-   Hj'ji'-ridr  to  -iT.y 

•_.  n  t:,oru'.ig:dj,  i-  vis"  d  a:el  c  iit-.M  h\'  Dr   Paul,  ai.d  'oro-i_';it 


PUBLICATIONS  OF  WILLIAM  Wool)  A   fOMI'ANY.  15 

T/ur<(j)t~uti<'S,    C/iol<  rd,   J tniijno.-*}*. 


Binz,  C.,  M.D., 

IT'ifi'ssor  of  I'liarmnrolopy  in  the  University  nf  Bonn. 

TIIK    KLKMKNTS  OF  THKUAI'KrTICS.      A  Clini.'al  (  HI!  !••  !  .  •!,.     \et!          :    \\.\\- 
ciuos.      Tran-lated  from  the  l-'it'lli  (iermaii  F.dition,  and  Kdited,  \\\'A,    \  i  :; 
iu  conformity  with  the  British  and   American    I'hai  n,  ie..p  >  :,,-,    l>y    l!ir.\  \KI>    I. 
S!'.\KK>,    MA.,    .M.U.,   Ox.m  ,    .Meial>er   of   tin-    lloyaln.!        •  of'  Phy- 
London,  Ollicier  <lt' Santu  i  Alpes  Maritime.-- 1,   Fran< •••,  i>  rm.-r!\    IJ:i  l.-!i    >•  T:.. 
liiii:  Follow.      In  one  handsome  1'Jiuo  volume,  '.>\~>  pa_>-.       Pound  in  •  \!ra  ;  . 
lin.      I'ritv,  ^.(M. 

''Fully   UTI    to   ttio    timc^  as   a  therapeutic  vance  the  movc-mmf  tu  f-talili-li   an  u:avi:-.;l 

pui,i,.."_l7',,/,,/,i    M,di<-'d  mid   Siti-ijii'nl  .!,,,(,•-  I'iiannafo]xi'ia."— A"  »•  /,'-/»../ 
/(»'•'.  "'I'iif    wurk    a[i[»-:irs   to    li;ivi-    !>.  in   -.vrf    :i 

"  \V.'   art1   much   mistaken,    howovcr,    if  th<>  with  m\ -cat  run-,  and    in-ar-*    tiii'    iniiir»  ,,i  .,._ 

\Mirk   in  its  prosi-nt  shape  does   not    lieeomr  a  lialiihty.  and  IM  a  vuluine  that   \vi-i io    :.•>:   .,•«;- 

t.''-neral  favorite  with  l>oth    student-;  and  jirac-  tate  to  ri-eoinnieml    in  tau  r»ti  .in_;i.-.-t    n.anne:." 

tituiiu-i-.s.     It  will  also  help,  wo  think,  to  ad-  — Tlu  M«l(' <d  U«-n,-<l.. 


Wendt,  Edmund  C.,  M.D., 


A  TRKAT1SF.  OX  C'HOLERA.  Edited  and  Pn-paivd  in  Association  with  J..ii\r. 
I'KTKISS,  M.D.,  New  York,  JOHN  1',.  HAMILTON,  .M.D.,  Sinvt-ou-c.-n.-ral  i'.  ^. 
^larin-  llo-pital  Service,  and  Ki.v  Ah  ( 'i.Ki.i.  \N.  M  ]).,  Sur_'e-.n  I'.  S.  Ainr.-, 
Illustrateil  with  maps  and  eii,ni.vin_'s.  SoM  oiilv  la-  snl'>er:pt  ion.  S..->- paj>-  ">1. 

J .-•"'  Availing  themselves  of  the  history  and  exjierieiit1"  of  cholera  ejii.l.-mics  to  the  pr.'~, nt 
day.  together  with  the  new  li^ht.  thrown  upon  its  mode  of  propagation,  ypn  ad.  and  Tie-un  •  nt 
tin.;  pa-l  year  thnniLrh  the  investigations  of  I'rof.  Kocli  and  others — the  kiioulcdu'e  e  MC./I  inj 
preventive  measures,  quarantine,  etc.,  so  recently  acquired  in  France  an  i  Ir-ily-  — th.  !•..!:.•  1 
authors  of  this  work  aim  to  proiluec  a  hook  which  may  at  least  serve  to  prepare  tile  pi"!,  --a  n 
of  America  s:icces>i'nliy  to  comhat  this  dreaded  scourge,  should  it  unfortunately  _:a:!i  .1:1  i  :i- 
tnince  into  imr  country  this  year. 

Burrall,  F.  A.,  M.D., 


'•  1'  i<  n  special  merit  of  Or.  I'.urrall's  timely  achieved   this    chief   cud   of   medical   rcs,':>.r< 

volum--,  that    it    so    .-tat.-s  facts    as  t<>  in>t  ruct  For  t  l;is  n  a>on.  no  le<stha;i  fi  .r  t  he  -.•:;, ,!  i ; 

ti:e    i-i-adi-r    most    i'liju'essively  and    acceptaMv  exei'lleiu'ie-,  (,1   this  ln-oeh'ii'e.  it   ]~  ,111  ••  !  o  c- 

in  all  r  ha'  n  iat.  -  to    preventive   measures  and  maud  the  utteiit  ion   and  r<  _ra''d   of  t'  c  pi>  :'. 

prophylaxis.      \\"e  irive  met  witli  no  writ  in^  on  sii.n." — .\T'il:<.'tl  //•  C'n'-l. 
ciioler  i  iii  oiir  language  that  has  nnji\'  happily 


Brown,  Harvey  E.,  M.D., 


KK1'<  >KT  ON"  (.ir.MlANTIXF,  on  the  So,ith<-ri  and  Culf  Coa-fs  of  t!ie  [.'nit.  1  >;;.'   -. 

Oil'.-   Volume,    Svo,    11?  1'a^eS,    luuslill.        Price,    Si    '.'"). 

Dclaficld,  Francis,  M.D.;  and  Stillman,  Charles  F.,  M.D. 

A     .MANTAl,    OF   PHYSICAL    DfAi  i.XOSlS.        Illu-fraU-d    uith    si:;  ••  r!-.,  t  •  •-   1     .::  I 
trali~par,'iit    litliouraplied    plates.      ()n,_.    vuluiii--,     It--,  '.111    pi    ••.:;:',•: 
S'J.  (ill. 

''  Tin  •  want    of    coueisi-ricss  in    th      or  1.  nary          lv  \\Y  canii"!   iina  :ine  a?i\    \\-\\  \\\  -\:\\<\\   •;••• 

n.  annals  on  ]iii\  ->ie-il  diagnosis  ;itrc<-t-  t  hi-  aver-  practical    .-,tud\    of   pin  -p-il   d:  i  ::,o-;-   ca::  ' 

a.;ij  student,  and  they  never  learn  it  until  com  -  mad.'  more    .  asy   thanl,\    ''"    ai.'i    ••'.'   *i.-   -  ;- 

j'e'le  I  to.      'l'iii^wii:k   is   an   t  \i\  ptioa  to   this  ]>•  rli     \\  .  'rk.  "-  -l'-i-  Jic    -!/•    ;.      .       -i.l    >M',et^ 

rule."—  ohm  Jf'.'.lic.u  JL\'-<ji\ifr.    '  J-j>u',^a:.. 


!•>          ITULICATIOXS  OF  \YILLIAM  WOOD  \-  COMPANY. 


Ranney,  Ambrose  L.,  A.M.,  M.D., 


V  PRACTICAL  TRKAT1SF.  ON  STRiilCAL  DIACXOSIS.  DKSICNKD  AS  A 
.M\M  \l.  I'oll  IMIACTITIONKKS  AM)  STl'DKNTS.  Third  Edition.  One 
\.'.,;in.  iif  ii'.'x  |i:u. •-,  iiluMrated  by  ;!1  ]>l:itrs.  handsomely  l>oniid  in  muslin. 
1'ii.-.  .  Si. ."ill. 

"t" -•  •("•;'    i'i)    a.'i'o'.mt    of  it<    systematic  ar-  and  in  this  country,  in  1  V'U.  this  is,  so  far  as 

ran.-.  :ii.-iit-"-     '  m        .,"fi   /.••  •  •••'    nul  I'linti;  we  know,  tin-  tirst  monograph  ever  ISMICU  on 

"  \\  •    aieat  a  !>•>-  tn  see  h'.w  more  iiilWina-  >in yical     (liagiui.sis." —  I'liilinhljitiin     Muliini 

f.oii    onii.i     ItaV'1     liii-!i     oni'ii'iisi-.l     in     tV\vrr  Tiimx. 

\\tir\-                ''.'.'•'     !/              •       •   <iil  iin'l  1  ..>'-  "Tlic  cliii-f  wmrco  of  perplexity  in  the  jirac- 

ti^-c  of  iin-dii'ini'  and  surgrrv  is  to  tind  out  what 

•  1'    .    s\>ti-;i     and                      cnl    of  tiir  vol-  is   tin-   matter  with   ilu-  pjitiriit.      rncoinfort- 

r.:i..-  .-,:.-  i.i.;i:I\  i-o-i  ;          .            an  i    tin-  author  alilc,  indr.'d.  is  tin1  ictlcction  uf  a  ]»i  actit  icn.-r 

li.i-.'.i                                 ,                 ^'H'/i'i-i,  J'i;t,--  \vlieiili.-liaslrftacaM-l.anda.ucdaiiddivs.-rd 

for  a  f>'it'-t'tr>    \vhon,    perchance,  it   may  IM>  a 

"A  \M-\   _   i  id     .:  ;    to  -.'ir-ic  -il  di,-iL.rno^is  for  flinlni-ntinii.     Dr.   Humify  has  given  us  a  look 

I't.n-  anil  licj;iii:ii-rs.      Asa  to  assist  us  in  ali  such    stati-s   of  unrrrtaint  v. 

-  il   is  ijr.iti'  \al-  and    ho   has   done  well  ;     for  in  I.IV.M  ntin^   tin; 

i                                                           II            .  syini'totus    of    dinrasr    in    niaikcd    rontr,,st.  it 

"\\\-:     th     -\  ••].•:.•:.    of    .Mad.',  id's    'Out-  makes  the  diagnosis  of  similar  tronMes  really 

;          -..id    Minuitdiioouaiv   in    Enuland  easy." — Tv(>  <.!<>  Jful.  un<.l  bury,  .limritiil. 


Guttman,  Dr.  Paul. 


A     HANDl'.OoK     ol"     PHYSICAL    DIAGNOSIS:    COMPTJIsTXf;    TUK    THHO  \T 

TIlnltAX.     \\H    AIIHO.MKN.      Traii>lated  from  the   Third   Ci-riuan   Kdiiioit  l.y 

Vi  r\.     \\i-n. i:.    M    !>..     i ".  '.'..v.    ul'    I'aenlty    ••     l'!i\  sieian-    and    Suri.'eoii>,    (;la>- 

•'i     llditi.'ii.    uith    a    colored    j.!ate     and     iniinei-ou.-     i.lu.-t  rations. 


Loomis,  Alfred  L..  M.D.. 


-''   •       '  '  '      :    '••     ,  •  i,  ,,,  lilish,.,!."— /;,  -,•-,;,'  //,. 

•  Ti     -i-   a  uork  air.  ad\   Well  and  l'a\  oralilv 
•    [uote.-sion.   '  In  th.    |  .re.-,  i,t   e.ii- 

i      text    i,a-    lie,  11    elit  "  IT !  \     I'evJSi  d 
|f     '•' "  •  i  d    1,\    The    addil  ion  ot    ti\e'  n,  w  1.  — 

•••  •     •          •  . :.  .i/, ,/,-,•„•  /;,„„,;„,,.. 

M   id.  -:t       ol     in,  dii  iiie     and    pnirhtioTK  r« 

•••     tin     work    to    n. e,  i    their 

•     -iiKi,  ets    of  wl.ieh  it  t  r,  afs       IIR 

•  i  ,  .  .    ;,-  d    .  >.-,-!.       I'  I  '  '  \' ,  ,  •' 

i--'  i.--i,.:  •••!•),    |,reviol;-    ,ditio]i*    of   the   uoik,    cr»n- 

'  '••    '\'-t  net   1:1  ,-,-.  ;  •    .       ....  x . .,  ,,]t ,, ,.,  ,/  tj;i.  ,,,.l,'r,.r  ,,f  ,  |:y-i- 

'!'•  '      ;'"'  ^    '  :       i:-tl..i,  of   t!,,-    eh,  -t   and'al.doli  ,11'  we 

'1    :[''                   ••i-'i-a. :»!:.. r  ;  i.-,ve         .-.r.i.-i    ;.-    runonyti.,    vi-ry  l«-t  v.oi  ks 

;••''•  d'.-    !-:a-r.  r    :•-   eon-  i.-ji.,      ir.  .• -I  .-xtaid    :.!:r|  h- !•!•.•  r-' rointm  ndi.-d 


PUBLICATIONS  OF   WILLIAM    Wool)  A   COMPANY. 
llutilluj,    (' I  i  inatoloijij,  anil  /'//_//.-/""  <:/y. 

Johnson,  Laurence,  A.M.,  M.D., 


Bell,  A.  N.,  A.M.,  M.D., 


CLIMATOLOGY    OF    TIIK    TNITKI)    STATICS    AND    ADJACKNT    Cor\TUIl> 

ami  •  >('  siii-h  F"i-i-i_rii  l'nrt>  ami  I'la.-'-.-  as  ha\  <•  ir.tima!.'  Coimn, Trial  1!>  . a':,.: 
v.ith  lli.'  I'niti-d  Stat.'S.  with  sp.-rial  r.-t'i-r.-iK-,-  t.>  Il.-altli  li<-s-n;-.  aiM  th'-  I': 
t.-.-timi  dl'  I'ul'lii-  ll«-:i!ili.  S.iM  only  l.y  sul'Srrij.tion.  S,-..  j,;,..-  :>\. 


Fothergill,  J.  Milner,  M.D., 


Till-:    I'HYSIol.OGK'AL   FACToll    IX    DIAGNOSIS.       A    \Y..i-k    iW    Y-      _•    Pi 
ti.in.-rs.      S i.l  .-.litinii.      Sv<>,  •,'.")(;   t.:i_-i--.       r.min.l  i:i  mii-lin.      s'J.'-'"i. 


Ashby,  Henry,  M.D., 


S-i:  :iMi«is      'I'lv-  a.i'  .:«\  v.;.~  in.|;i,-i..|    (.1    l.rin^  n.'vs.  Tlir    |)ii.-tl    --    (liap.i-.Nrr-, 

til    •:.  o'!t    i"   |  •:•!!:•.  ill  t  :  .•  !miu    t  l;:il    t  ::•  v  mi-  ii'  T!i.  •  S.  n.-.  ~.  >:•.  .-.•::.  :ir  ,  I  <  I:  ^.\i.-  .   •  I  .•  '  .  I  •.' 

|.t...  .       :-.:'.)     tu    •.     wi.j.T    "cl:i«s    nf    -ti.<i,-ut>  HM.l  t!:.'  Ai'i  .  M  li\  ;   In.;,  -t  mi;.!  I'!.  .  -'       M. 

(.^  i-iin'-    :npl    (ifnv's    Aiiatoinii  s    airi     l''o.-t  .'i''s  Sy-tcin.    an.l    Tl.c:  nn;!iii-T,-i     .- 

i.;  »>:    whi.'li  !niu'L  ol'  t  ln>  i:il'i»nnati'.u  r.  iiit  ai  :'..'!  l»  M.iv  r.-a1  ii!  v  a  .  ,uia  !>!'..  " 
i::  '..•-  v.  i.fk  \\a-i  I'liuii'lc  i.      'I'no  n.-v.'iitft-n  nt\'- 


Comstock,  J.  C.  ;  and  Comings,  N.,  M.D., 


riT.I.irATIoNs  ol-1  \YIU.IAM  WOOD  &   COMPANY. 
/ '//  txiolot/tf. 


Kirkes'  Handbook  of  Physiology. 

11  \N  !>!'.«  ><  >K   <>!•'   HI  Y~-I<  >|  <  M  ;  Y.      1'v  \V.   MiWKAXT  BAKEH.  F.R.G.S.,  Sunjpon  to 

St.  Hat'tli.. l"ine\v's  llo-pi'.d  ami  » 'oiisnltiii;,'  Smx'eon  to  the  Kvelina  Hospital  for 
>i,  k  (  hil  ii  ii  .  I. eel  in  ['  MM  1'h;.  -:.•':.._  v  at  St.  I'.art  h. 'li'im  \\ 's  Hospital,  ami  late 
Met..  Hoard  i't'  Kxai'niners'  of  the  Royal  Colle-e  of  Stin.'c'<ms  of  Kni;- 

1. in. 1.  an. I    VIM  INI    i>i'K\ii:i;    ll\i:i;is,    -M.l>.    J."inl  ,   I  >.  nionstrator  of   IMiysio!- 
o_  \    at    >t      l'>ar:h. 'loniow 's    1 1 .  ..-pital.      Kleventh   edition.       In   one   volnnii1,    with 
.iii. I  livr  hundred   illustrations.      Price,  muslin,  £-l.(HI;    leather, 

S.'i.tH  I. 


•-.     .      1'    li\      ;.•  .   tlii1  lit"-'    developments         "  As  a  jjnidp  for  the  student,  ami  ready  rcf- 

•  •.-          :    it    treats.     The  illus-  rrenrc  lor  tile  jiractitioiier,  tliis  work  is  not  ox- 

•     .•         -  .  ••     ui    !    •    ii-eti'.l   an-l    will    lie   found  relic. i    l>\    any   oilier    in   the    IMI^II>|I    laii^Mia^e 

I    I.,   tin       '   ;  i.  'it    in    his   rtinrt-   To  for   the   eieanir.-s  of  statemt  1,1    ..!'  e-tal'lislied 

•  i    inaster   eVi-n    the   inii>t   inlri-  farts  in    tin-   si  iriiei-  of  \\hieh    il   treat-."-      T/u 

,     •      •  •."      '/'/',,    //„/,,«-  S.i,,;!,,,-',,!!,.  X,  w  York.   April.   INX,. 

.     !'    da  1,-lphia.  I'a.,  July.  1  ^.\  "Tin-  Messrs.  \\'ood  uo  not  intend  to  ior.uet 

'!•!;.'    ••  ord.-i  of  Milijcel  -.  and  arrange-  t  lie  juniors  and   i;ive   tlu.-ni   th^r.-lon-   tin    hest 

•    :    •     :         i:oii1     th.     \olii in.      are  -.vorks  at    a   nominal  prier.      Tin  re   i~   i  ardlv  ;i 

I1...-  '        •    i.    ;i-   M    handhook.    the   ah-  j.iaet  it  KHUT  ol    s.  inr  \ears  who  oid    not    It-am 

I    aru'iinii  nta'ioii    on  the  piinriph  s  of  physiology  from  Kirkt-s,  and 

I  litioMal  reeoiuini'iulat  ion  any  work   \vhieh    n-achc>  an   i  1.  -\.nth   i-diiicni, 

I'll,     illustrations  cm    har.llv  !».•  show-  it  ^  intrin>ie  value." —  '/'//'   ,\  "/•'//  .li/n  >'- 

•  ;  .    •.      P-  \\vll    diawn'und  i>'"'<    .I»n,-i<,il  ../  //..//,.,  ,,t,,  ,(/,•/.    I 'hilaiielpliia, 

thi-,  is  the  chief  end  of  a  j.iet  -  Ma\.   I  ^S."). 

.   .•  ;    .       :,-''•.  ;  '"     .!/'.•/•-          "Kirk.  >'    Ifandliook    has     IM.-II     a    popular 

.    I.    •-•>!!:.   K.V.,  JiilH',  1-S.\  t.  xt       ook     of    physiology    for    >o    many    \eais 

"T  .;•!'  us  i-   a    revi-ii'ii   and    im-  that    its   flcvt-nth   edition    hardiv   calls   for    an 

I  •  '  '    \\    •    .-  -     I  ';  \  -r        ...        I  '    ]  -    a  ext.  ndi-d    no'  1C--,    much     h  -<     a     I  f\  iew.       It     is 

.     :      i-vc.il.     ;    «i.vk.      .       .      .      To   tiio>e   i.f   us  enough   to   say  that,    th.-   editors,   wiai   are    n.,\v 

vs.    paid   n-v.  n  ne.  •  to  praeticaily   I  h.'  authors,    have  maintained   1 1m 

:         '  •    ;  •       Kii  k.>.  this  hook  com.  -,  as  ;i  iii^li  eharaet.  r  ol  t  he  work,  and  Inn  e  kept  I  id- 

:    :  •  •    .  • .   i     ':•'•!.    a:.  1    p.'.-  1\"  lip  t  o  t  he  t  lines  in  t  he  si'iein'e  oi'  |  ii .  vsinlo^v, 

:    .  made  -in  h  \ast   pro;;i'e.-s  uitliin  ti.e 

:  •.     which    liav,      '.,n  .  .  - 1   :'.  \v  \ .  ar<.  "      '-./,'//,,  ,;/•*  .]/,  ,/;,,,/,/,,,,,  -/,,,/( 

P'.c  •  i.t   time.      \\  ,     •    ;••.     o;  ,M.  \  .  1  -••:>. 

-  •    i    •  -       •  •      ik.'        /'',.      >-,'',,'.,          ••  On  i  lookmiMhroniJi  the  last   edi- 

\'a  ,  Ai  ril,  1  --."..  tion  of  Kn  kes' 'I'hyi-ioloiry.  which  is.  Imwevi-r, 

'    •  i    \\ork    has    I » -en    tl lor-  rea     v  K      - .  •  -     it  si-ctn-  to  us,  <mlv  t  hroii^h  the 

ipto   tiie   tim.-s.  co',iri.->y   oi    tin-   editors,  we   can    tin. I   scarcely 

I'  .         .    i,,,,!,   |',,r  iin\  i  him_;  to  criticise.      It  seems  thoroughly  n;) 

1    ,  •  •        n  '   ,    i  he   lime,  /nid    u'lnle   moot   poin'-   in  plnsi- 

•      •     •     iins   I     i-ii   ei      in       :  •  not  h. -i  n  entirely  om ii  t.-d.  they  arc 

'     •  tun      .ei        rated  in  -neli   ii    \va\   as  t,o  nnder  t  hem   easiiv 

-•    •   •    .          '  •        ihe   t<xt    ha-  cempreheii-ihle    to    the    youim.-t     -indent     of 

V-       /  Tl,-  I-H'IH  /it!,'  I,.,.:,  /!•  .    May, 


Lambert,  T.  S.,  M.D., 


;!M\i:v  -v- i  KM  \T!I    H  i  M\\  iMiYsioi.ocy.  ANATOMY.  \\D  nvr,  n:\i:. 

-    and    el  a-silieat  ion.  ln.t  h    -im  j.'.e  and 
t.-d  to  tli-.  ii.-.    of  yoiniu  scholar.-,     due 
-  .       :  l'i  ice,   's.'ie. 


Brodio,  Sir  Benjamin.  Bart.,  D.C.L., 


PUBLICATIONS  OF   WILLIAM    Wool)  A   COMPANY.  !'.» 


Harris,  Vincent,  M.D., 


Power,  D'Arcy,  M.A.,  Oxon., 

Mi  ail.iT  nf  tin-  K'-vnl  Ci.ilt'Ki-  "f  Siiru'i-nn.--  ;    Lit.'   .  \.--i-tant  IViii.'!!-:  r;a»r  "i"    }'.••,•-'.•  ''.••-•••    :'    -• 

MANTAL    Foil  THK    I'll  VSK  >!.<  )(  IK  'A  L   LAI'.olI  AT<  >Il  V.      OIL-   v...;m   .    -         :    t 

].ri_--'S.  !'"i-t  v  ilhistra'ioiis,  m'i-lin.      I'rir.-.  Si.  ."><). 

"'I'll.'    pivs  .'it    littif    volume.    r.h!n>u<:h    of  -.TVC  tin-  ix-oil*  of  any  who  may  <i.--iit-,  t'-.i    n.-li 

me  I'  .-t   pit  t'-n-ions  ami   narrow  in    -oopi',  i-   a  nianipuluUs'f  study,  to  familiar;/'     \  '.!<•:•,-<  \\  ••- 

rcli  i!i!f  ^uiile-lio.ik  for  thi-  stmli-nt,  who  tlt-siri'S  with    flit-  .-ssi-i:tial>  of  hi-tolo^y.  h:-t"  < 

tn  l.'-ira  s.im.-thiiitf  nf  tin-  ni'iiint-iits  of   hist>>-  i-try,    ainl     physioloL,".  ."      /.,,//,V.r 

h.jirai  m.-tholsan.l  liist..-rii    mi.-try."—  -Me//-  .Wx,  Octal.fr"->,   1  ^Vj. 

,  ,//  /,'.  ,.„-./,  S..-pt'-m'o.T  ".  1  vsl.  "  Ti.i-  lit  t!i-  liook  i--  a  'i-j-ful  ai-!   T..  >s,  rk  1:1 

"  T  hf  prommt-mv  Lfisvli   to  1  a  1.  oratory  work  the  physiological  lal  'oratory.     It  -  main  -•  r-  !._rtli 

in   all  well  i  iiuij.  ;•(•'!    m.-'lu-a!   srt.o  .1-   Iris  fro-  li.-s  in  t;ic  .lir.  rtion-  iris  .  n   f..'-r.  .'.•!,.•  iu_  :::i- 

ato-i   a   ili-:riai.il    for  surii    i"  .ok.-,  as  r  >•,••  vohnnc  ci  o-ooi  'ic    c  xaniinat  ions    ol'     i  :>-i;i-s  "_./'',    './- 

utnlvr  iiuiiri-,    wi.ich    is    in  i  vrry  way  titlnl  to  tl-'jj/i"i  .!/"•  '/.'-•".'  /';'«<-  v,  Ooioljcr.   !^xl. 

Satterthwaito,  Thomas  E.,  M.D., 


A    MAM'AL    <iF    IHSTOr.OC.  V.      F-Mit.-l    nii'l    Pr.-]>:ir.MM.y  TimM  \-  E.  S\TTI-:H- 

•|-iiu  A  i  n-:,  M.  i>..  i.f  Ni-w  Vurk.  In  a^sm-iatioii  \\  itli  Di-s.  Tin  .n.:,.-  |)w:_ht.  .1  .  Col- 
lins Warn  a.  \\iliiaui  F.  \Vliitin-y.  (  iaivnn-  I.  I51ak.-.  ami  t  .  II.  William.-,  of 
l',.,-to:i  :  |)r.  .1  11,-MrvC.  Siin.-s,  .'.f  I'liiia.l.-l  |.!i  ia  :  Dr.  llfiiiamiu  !•'.  W.  -ri..",.  ,k. 
of  Ui-onklyn  :  am!  D'I~.  K'lmmnl  C.  Wt-n.lt.  Alu-ahain  .May.-r.  It.  \V.  Ami.  Ion, 
A.  It  Robinson,  W.  II.  Uir.lsall.  D.  Brysoii  D.-invan.  C.  I,.  Dntia.  ami  W.  II 
I'orti  r.  of  Nt-\v  Vockcity.  N.-iv  .-.liti-.n.  \vitli  appi-'iaiv.  hii.ii--  !,:.:•.  !s.  .m.  •  vvo 
Voluiii.-,  jirnl'iiM-ly  illii>t!-:i{,.,l.  -iiiii  [la-i--,  luuslin,  I':';.-.-,  s!..~.n. 

'•It    '.viil    tiii-1    a    ivn-lv    wcl'-om,.    f:-,  m     ail  iiion-  ncc.-ssar\   to  pliV-iria':  •-  v.  i:o  w.iu".  I   K.-.  p 

\sorki-v.~  HI  this  .Ifp-.rtnit  -lit.  as   h.'iii;;   a   tr'i-t-  aori-a.-t.  uith   m.-iiical    p:o_:r--..      Ti.i-   «oi'k    is 

worthy  iin  t    \alualilf  fpitomc   ot    t,:.f    s-.lijf  t,  all1:.-  cruilita'iK.-  to  the  .••iit'.i  —  as  !.«•  ispl.-i-nl 

ai-i-or  .linu    to   t;.c    lijht    of  t  In-  most  ivi-t-  •  i  in-  to    (iiil    hiniM-lf-    hi>     collalmrai  or-.     ;.:.!     t  i;- 

v.--;L'ati  -us.    ami     a-     ln-iu^    l.y    f.n     t!.c    !  c-t  m     liral    (>rof,-<s:i.!i    in    tii.-    I'nih    ;    M-;t-.s 

Knjii<h  t'-xt-'.ook.  a>  a'iapti:  i  to  t'.r  want-  of  '/'•',.    ^-i-i-l-n-'i-in,   N.-w    ^"olk('ll 
f,,    -'•!•!.•  :t  a-i'l  ti'.->  ;>:-ai-t   tio-,,.:-  ;    a-,  su.-li  Wf  "Wo     woiiM     rfcoiu:i:i-!:.i     tin'      '  MaT.'i  il     ol 

hnrtilv    n-  -oMiTin-riil    it.."  --.In.    ri--'ir>   •/•'(r,"l:  Hi>:o'.o,'y'    to    any  ].!:>  -:.-i  in    or    -•   :•!••.: 

,.'///.     '(/•     ::''>     S'-   .'•'"'  i  S.  .  l''>iri   s  |  .,!,,.  ],i-,  ,|'U.  j,  ;il    :•'.!•..!•,•  'Mr;,:    ...;,•;,•- 

••Tui.-   hook   i-    what    it    |,ur|i,,i-ts    to   1..-,    a  -  <  '>,  ;.„.,.,  )f,  .;;,•„:  J   „,•„„>,  ,...;!•;.. 
iiiaiiiiai  ii.  l  !  .-  ti"i--  -I-M--  •  ">f  I  in-  wi  if  1,  an  I  wi.l  "  Ti.i-    i-   r.  a:!\   a   s.ip.  :  '  .  v  .  .;k  .  .    .  ;     • 

ni'--t    t  hi-    W.IMI  -'•    ol     I  .'.<•    '  '  :--\     pra"'  it  imn-r.    a-  .-01:  .!.'    for    I  is     t  iio-i      i  \\^.,i  _•<••  \    .:.    • 

W-  II    a.-    tii--    .-:•:  I    lit    sv!i  i    I.-     :i--  I  .  .  •.!••:  m  ---iciii  ;  \M«I  k.       Si  irli  a  u  •  n'k    !i  -  t  '.  is  .-!:•.-•,'.  i  '    .  :  .  •! 

r-t'i  1-.    in  tin-  i:n;Hi!  Ian1    il.-[i-ir!  :i.i-iiT."  -.)/»  .//  in    coniiinct  ion    with    phs  -i  .!o.r\-.   -.  .    r   •   ,.-• 

,•.,'   7',,,.  .v.  -Mil.  -lit  isa'.lr  to  follow  al.  n.:  v.   •   .  •...    •-.-.  n. 

":,,*,>, 

i   .  v  m  i  'ir  r  ,;i,.;ji.     -is  a  tr  •  MI,'  .-!:,   s  in.-  lie  :  on.'  "It  nn\   !,r  --ii.|  t  lv,i   >ati.':  ri  .v  ,i        .      \I  ,n 

fj-  f  i  !•_'••  of  i.i  ,|-iv     ami    !'    ni'i-.  :                              1          i 

••  In    .  !  -.    ..--:..  ,-!     i!     i-  :,   •    ...':  -V,'   sv,    can  .  ':i  1   -1  .....  '.:    >',:    -".,|,n'-     .-.  I    i  •  , 

I,.   ,-:•;.•  -H'.r'i-  M-l   to   a:!  v.  !i      .i-      r.    t  ,   -i  nis  \f-  <  /:,-,>  /.:  .  ,  r-l 

t   .1-  i  -i..-  an  1  i:s    fi.i  l.i-an.-i.  of  m.  ill-  "Tin    app.  miix  .-..!  •  .r   -  ::  '. 

\'  ••',   ::  •    .1  ,i    ,  ••      •'     :.'   •     .,•    ,<,-•!     r-.-.-n-'s  a  H.  i  •  .  i  .:-'.- 


Thudichum,  J.  L.  W.,  M.D.. 


I'l T.LK'ATTONS  oF   WILLIAM  WOO!)  ^  COMPANY. 
J^JnxioIoii/,  I'<ff/iolo(t    <iii<f  Tin  /'<! 


Strieker.  Prof.  S., 

D:  V:  i. n  ,.  Angina. 

A  .MAM'AI,  <il'  HIsTo|.oi;y.  Written  in  en-operation  with  Til.  MKYNKKT,  F. 
\.>N  l!i:<  Ki.iM.HAt  SKN,  .M  \\  S<  in  I.T/.I:,  W.  WAI.I>I-:YI-:U.  and  others.  Trans- 
-,  II  i  M;\  l'owi;i{.  of  London  ;  JA.MK.S  ,1.  I'i  TN  \.M  and  .1.  OHM-:  (JKK.KN, 
,:  |io-ti,n  ;  Hr\i;v<'.  KN«>,  TIHI.MAS  K.  SATTKHTHWAITK,  KI>\VAI:I>  c.  SI-.CIIN, 
1.1,11-  1>.  Hi  I.KI.KY.  KI>\V\I:I>  L.  KKYKS.  and  I-'I;.\M-I>  K.  DKI.AKIKI.D,  of 
N,-.'.  Vork  Ann-rican  translation  edited  hv  AI.KKKT  11.  IlrcK,  Assistant  Aural 
Siirj.-oii  r .,  •!;,-  V  •-.  V,>rk  Kve  and  Far  Intirmarv.  One  voliinii',  imperial  Svo 
l.'ni'i  [,.,_,-,  four  hundred  ami  thirty-cmo  illustrations.  lYi,,-,  muslin,  ^'.'.00; 
!•  atleT,  if  in. i  in. 

A'  •                                    ;teiided    and    valuahh-  phv-iciain    and    surgeons    who    would   pursue 

tr,  it ; -•    on  1  li-:olo ••%  which  ha-  yet  aiipcared."  their  depart  me-ifs  witli  all  t  he  li^ht  of  modern 

_  1     ..                                                       I/,  ,/,>„;  .S,/,  ,„-,.<.  science  '•       /'//,/,„/,  /,,/,,„   M. ,/;,;, I    Tun ,  *. 

T    •   •                       uf   Mr.    r,,\%.  is  covers  -llH'i  "  The  need  of  a  work  of  this   kind   has  he,  n 

present  edition;    hut  the  remain-  felt  for  some  time   past.     The  last   edition   of 

1.   i    h\    the    American  Kolliker  contains  points  which  he  himself  has 

^. •!]•'•                          named.      Nearly  two  thirds,  altered   in   hi-  lat.  r  eiitioiis,    which  have   not 

tin:                            U,ok  an- tran-lated  hy  Amer-  heen  translated.    The  pnhlieation  of  this  %%-ork 

:                                   vsiciaiis  ^specially  interested  is  ile-tim-d  to  ^iv,-  increased    y.c.-t  to  t  he  st  uily 

•     •                                                         ,\     have    under  of  minute  anatomy,  a   study  which    i.-    l.ccoin- 

I      •      ;  ;i:cie  i-   e\i  lei  t    advantage,  as  in^  a  in-ce-sity  to  any  one  who  desires  to    he   a 

1\    familiar  with    a    sii!,],  ct  is  thoroughly  educated  physician. 

•  .     •                               rasp  nhscure  jioints,  whicli  ••  \Ve  I.elieve  tins  li,,ok   to  lie   indispensahle 

.•-.;•-.  d  st  ill  more  oh-cure  hy  lie-  to  any   physician   who   desires    to   understand 

loieiirn  idiotn.      There  is  .-d-o  the  pr,  si  nt    ]io-ition   of  medical    science,    and 

—    ahont    an    article  to   kno\v,  it'    not    to   tind    out    for   himself,    the 

•'i    -   -     ,-  -  ate  i  than  if  it  form,  in  the  original,  present  knowledge  of  thu   minute   anatomy  of 

•    iniher,    and    l.y   different   an  the    human  hody.      The  author.-,   as  remarked 

•   .          :       •     •    lividnal  :  for  the  liefore,  are  men  who  have   <l--voted   them-elves 

must    n.  ce-sarily    jjrow    ujioti  to  these  studies,  and   do   not    limit    themselves 

i~  not    re-  to  communication   of  the-  facts,    hut    in    many 

:                   '                                 !  -iiniliarit  %    %vliich    he  places  tn  at  of   t  he  met  hods  of  olit  aininu'  eood 

•i.         .      ('lire  if  t  in-  papei  s  an.-  all  hy  t  he   same  s]  ecimens  for  self-study. 

••  A.-  tot-   the    I'ook   it'-elf,  it    has  heen    pnh- 

I          -    i ;,- of  papers,  edited    um1  in    many  li.-hed   m    jood    -t\le       Tin-   tvpe   i-   char,    the 

.::   •                       '  ••  n    1,\     1 'i  of.    St  rick,  r     con-ti-  %vood  -cut  -   are  e,  pial   f  o  t  ho-e  of  the   ( lertnan 

•.,••,      •    extend.    :           i     most  iditioii     and    there  are   l,ut    f.-w   typoirraphical 

i    •               ••      ':-,     on    Histology   •  M  int.      And  errors    '— '/'                   >'  /,''••,,,•,/. 

-  !l     -.    •     \  i-   a    suteject,  \vliich  "  ]-]\  ery  medical  student  and  every  soientifio 

•  •    '    ••  -•    and    mo-t    accurate   in       practitioner  -honld  -tud\   this  %vork,  as.  hetter 
;•-    dd.   ihiswork    musi   n.-cessa-     than  anv  ot  h.-r  in  t  he  I'lnirlish    huiu'iiaire,   it  ex - 

i  •     ,  r-     It  Incomes,  therefor.-,     hihit-  what  has  !,,. MI  demonstrated  respectnij; 

•  i    e\.ry    ld-tol,,^i-i      fli,    miii'ite    -t  rnct  lire   of   tin-    hod% .  "—  />•  !r»,r 
,      •         ,vor!  !.    i-  N',,  II  as   to  all      U- ri-  -/•  ,>t   .)/,•/,,'/„, 

Gricsingcr,  W..  M.D., 

• .    1. 1  ,,r  M, 

• .  •>      M,  in1, 

I   \l.    l'\TIInI.i  H.V     \M>  TIIF.IJAIM'J'TICS      Ti    i!.-lat,-d   from  the  flennan  hv 

II'.'I      '      •"'-.    M.I),   i    tin  M,          .,    Sup,  lint,-:, deM    ,,f    tlie    Sns- 

,.    II:.;.      aid-    H  nd    .i  \MI>  111  '1  ill. 1:1  uI!H,   .M.  I).,    Kdin- 

W.-od's  Pocket  Manuals. 


,.-    ,.   ,.,.     ,  ••  .  \    ,     nvci.tMit    li"'.    pock'-t    manual:    ili- 

1  iei    ai-ci  li-nt-    ai  ranged  in    alphahi.-tii.-Hl 

;•  e  pr-'-crij  lions  of  \\  ell   l;ni,un 

T  .         :iv.  n  under  <  a'ch  ln-ad."-     ('>>.•  />  > r'«- 

•      io.  k  i,v,..  ti,,  i        .  ••,     \,,v,  „,!„  ,-    l-v]_ 

n%.  nicM    little  hook   for  ha-ty 
•  if   '!"    '.'•'•.'  '/• .   Novcn.!,,  r, 

//  •'-,        :/ 
I,.-:    '-: 


ITBLIf'ATIONS  OF   WILLIAM   Wool)  \   roMl'ANY.          'J  1 

M  t<'/-(>«<'(>>/. 


Brocklesby,  John,  A.M., 

IW.'-v-or  .if  MiuIieiiMiies  .in  1  Nutur.U  1'hi'..  '-<.].  hy  in  Trinity  f,,i:,-t;,',  Hiirtf'.rl. 

TIII:  A.MATKcii  .MI<  KOSCOIM^T  .  ,.r,  Views  ,>f  tin-  Mi.  ,-,  -,,,,,,,•  Wmid.    A  n,i:,,( 

Look    of   .Mi.To.M'opic    .Manipulation   and    M  i.-r<  .-.  opic   (  il.ji-ci.-..      liiii: 

two   hundred  and  forty.  M-vt'ii    li-iir.  -    on    \\o..d   and    >t"iie.      (in--    \niuH.B    fSt 

Ml    pa^e.s,    muslin.      1'ruv,  sl.i">. 

"A  little  liook  full   (if  eurioii-  and  interest-     examination.      .      .      .      'I'll   re    are    ;.'..,-     •  • 
iiiK  fact-  re^anlin:;   thf  microscopic  worhl."—  -     hiimlr.-'!  :u,.i  ti!t\   illustrations  l».  -aut:r.     •,   .  .. 

n,,,-  y..,.,,,/  /••,,//,-.s:.  cent,-,!."   //',/,.  ;,.v  •/;.,.•',,,-. 

"  I'uMi-hed  111  Very  beautiful  shape-."-  "The  In.  ok  is  tim-lv  uott.-u  up.  ami  u.  111. 

f:'/;  „!„,/  .(/,;//.  found  ii-i.-ful  t.i  all  t.-acli.-rs  \\lin  .1.  -ir.  t  ,  ,  \ 

"  It  ti-.a;s  iif  th.'  mitTi>-ri>i>i'.  lui\v  to  use  it.  t.  -mi  thi'ir  kin>\\  irdu'f  into  tins  ni..-i  int.  j.  st- 

and how  to  jirujiaro  iiiiiTuacu]>iu  u'ljccts  lor  ing  iluiualu."  An/i.^im  '  'it-j  J>  i".r,  fii. 


Frey,  Heinrich, 

rrofi'.-Mir  of  Me-iichu'  in  the  T'lc.vt  ivity  i.f  Zurich. 

Till!    MICROSCOPE   AND    MICROSCOPICAL    Tl'.cil  Nnl.i  x;  V.      A    T.-xt-l k    :.. 

I'h\-ieians  ainl  Stnd-'iits.  Translated  and  Ivlil-d  dy  ( !  Ki  i.  li.  Cl  III  i;.  M.I) 
iSni^it'ii  New  York  M\e  and  Liar  Itilinnarv  .  (  Ipht  ha!  in  i.  and  Aural  Sui'-o"!:  t' 
tin-  >t.  Catherine  and  Williaiasliuru'  Jltispitals.  i-tc  ,  e'e.  Illustrated  l.\  'hie. 
hundred  and  ei- li!  V-IML  lit  I-IIL  raviiiu's  on  wood.  On.-  \oluine.  v\..,  1'iiiup.i..: 
I'j-ico,  muslin,  si'). nil:  or  color. -d  leather,  Si. nn. 


. 

"A    .'onipli't.'    r\po-inoi!     cif     tin1     suliirct,  "  Thus..'  \\  ho  arc  familiar  -wit  h  !j'ri-\ '.-  a.L.ii 

thn:'(i-.ii:iilv      iinlisi'i'ii-aliii1     to     til.1      jirai'tii-al  ralili-   manual  will    I',  i-l  urat.'l'ul   to    l>r.   (..!!.•: 

iiii'.'1-o-i'i.i'i-.t."   -•''/,:,  •././.<   .)/.  ,i:..i!  .!,>•!  ,-•,•!<.  I'ov   l;:s   vi-ry    r.^ulalil"   ;  ran-1  .t :.  .n.  whirl!   .;ii- 

"  Tin1  v.-ork  is  iiri'.-c'itr.l  vcrv  Tiioiirs'ly.  yi-t  i.li-sour  A  iin-riraii   an.i    l''.ii^ii-.li   -tii.:.u;-  wl:n 

\v.-  tit  ill  it   in  >t  UM!V  vi  TV  ai-riirat  •  in    all  its   <!,..  an-  iinai_'i|Ualiiti'i|  with    t  l.r   ( irnnan    to:..   :••  '•. 

taiU  ol'  ])riici-.-,s.  1 1  it  roin  jiii-ti-  as  r.  Lfanis  varii1-  ].art  icipat  ••  in  tin1  in -inn -I  i.  -n-  of  tin-  ivi'o  A  n.  .1 

t\   of  toj.ii's  trrati'il.      Tli-1   C'lii'lcnsi-il  stylr   of  /unrh  |.i-oi'c---or.      Tur-"1  <lh  i-rt  ions  f  •!    i  .  \  .  - 

the  author,  th.1  fairness  ,,f  his  natiiri-,  to^i-t'ln-r  t  lira  t  ion  possess  an  espi  i-ial  value  to  I  lie  A  :,  >•! 

witii    ins    im  1.  rstamli'i^   ot'    hi-tolu^v.  permit  iean     observer,    1,11     aeeount     of     the     •  \'.':".' 

an  :inhiasseil  lii^.'ussion  of  nearl v  all  i|iifstii-)iis  manner   in  which   ai  e  iieseril n-.  1    !  lie   mat.: ;    '.'I 

of  nncr.  s.-opie  anaio;n\',  ami  man1,'  of  oli-ciir.-  im  pro  veil  nn-t  hmls  of  il-  mon-t  •  at  n,.;  :  .  ••  .     .  i 

pat  'loln^v.      Tli'1    rules    for  test  i  tli;    aii'l    s -leet  ous    struci  ures     in    their     luallhy    or    ills.  .1    til 

in_r   an    uist  rum.'iit   are    c.-pecialiy  valualili-   to  con, lit  ions.     To-uni  up  all.  we  t  iiink  tliat   '   :i.- 

iine    alpo'.lt    In  piirciiase.  "-  --  A".  -'•    Y"i'!,'    Jintritnl.  l.amU.'me    \olunn1    i^    one    whiell    t  he  \v. '1  k  1  u.; 

at' .W  i/ii'iin  .  miei-0-.copist    cannoi    ail.ini    to   ilo  \\  it  hunt  ' - 

••  Wo  conceive  t:-is  wi.rk.  df  all  others,  ],ar-  /'.',: ',,!, ',,',.<  .I/. ./;../'   /.',/,-,<. 

tieulariy    htt.-.l    Kv    i:^    comjileteiiess    anil    ar-  "\\'e    aihi-e    all    COIMIII    neiii^    the    ~',';i\    i' 

raii^em.-nt,    to    -erve  the  stn.leiit.  wlirtliei1   I).-  !M!cro~cop\     to   |nirfli:i-.e    l-'re\    on    ::."     M  i 

-inn. T    or    one    far    :ut  van.-eil.       The    hest     ami  .scop,-.  "--  -  A'/^/r,,/. .   .I/,  ,/;<•„!<,„',/  ,s  .,  . 

nio^l    recent   methods   are  here  i,'i\  en  in  iletail.  ml/. 

The  add!' i  ins  of   the   i  .lit  .r  ma  ke  t  his  part  of          "  1 1  is  a  pleasure,   indeed,   to   cali    tie   a' '    n 

the  Wol'k  eiimplete  to  tile   present    time.       Ivacil  tioll     of    tie    protessioll     t"     thi-     >  i  -r\     -     ,'    '  ii.l 

tUsiii    .and  on:  in    i-   t  feat  e.  I  u  it  li    a    c.  nnpl.-te-  work.      \\'it  h  I  his  excelleni   \\orktii.      "   .i:n,e! 

nes^    iimlt.eil    niily  liv    the    present    progress   of  and  the  e\p.  rt   po-se-s    ,-illthat    cai     '•  id 

microscopic    art.      The    translator   and    editor  for  the  pro-ecu!  i.  .11  "t' their  -' udi.-- 

<le-crves    til,-    ^'ratit  mle  of    t  he  In.  .  1  ieal  profi'S-  t  i^at  n  ms.  "—  /,',!•  'nt,»  /(./',',(.//.." 

i-ion     for    pia.-iii^    In-fore    an    Ku^Ii-li     leading  ,l»nrii-il. 
pulilic    Dr.     r'rev'.s    work,    lend. -red   still    more 

Carpenter,  Wm.  B,,  C.B.,  M.D.,  LL.D. 

Till:   MICIIOSCOIM-;    AND    I'l'S    IJI'.VKI,  \Tln\s.      Sixth  IMitio: 


:>:?          I'lT.LK'ATIONS  OF  WILLIAM   WOOD  \-  COMPANY. 

/•'oot/x,  ./ '(>/>•"// .v,   Snr</i)'t/. 
Pavy,  F.  W.,  M.D.,  F.S. 

A   TKFATISi;  ()\    Foo|)   AND    DIFTKTK'S       S.-coml  Fdition.      Sold  unly  by  Mib- 

.-criptl   .11.       See   i,:,_re  .V>. 

Blyth,  A.  W.,  M.R.C.S. 

Tin:  \NAI.YSIS  OF  FOODS  AND  TIIK  DKTKCTFON  or  POISOXS.     with  n- 

hlstratiol^          On.     Volume,    1'Jlllo,    -Id.!   panes,    Hills'.!]].        Price,    Sl.(H). 

•   This    w..ik    consist*    I'f    t\\u   parts.      One  are  obtained  by  processes  of  distillation,  being 

,j,. . ,,(,  ,i  tn  th'    AIM]  -  sis  of  the   principal   :irti-  eonsidei  •  d     Ins;;     and     in    the    second     place. 

,.;!,  -    ,,f    |)i,  t    in   ,i;iiiy    use  ;   tin'   otncr    to   tin-  those   extracted    by    alcoholic  or  ethereal    .-ol- 

I),  ;,  i-i  :.'ii  ai;  1    M~t  iiuat  :on  of  I'oisons,  uryanii1  vtiits.       Ti.c    //.../v/"""     /'.</'M</«.V,    tinally,    an- 

;.:      inoru'itiiii'.      liiiii'    tii'-i  j'l'i'tinn  tin1  iiutlior  tak>  n    in    tin1   i>i''!«r   in   whicli    they  may    IHC.M 

IK;-    i  ii'i' avurril    t"    u'ivf    a   clrar   ami  concise  nimvnirnl  iy  lie  bought." — I'.ji  i-ii-t  j'r<nn  /';•»_/'- 

H                 nl    ti.i    various    l-'noils    and  licverairi's,  r/o. 

witn    t...     In-.-t    and    nio«t    rrrcnt  .Methods  fur  "\Vili    In-     n>c.'i     1/y    cv-ry     analyst." — /'//• 

t:,      11,'tTMon   nf  MI\    Adulterations.      A    few  /.. ///--,/. 

il!..    :             inu.ort.tnl   1-ual  ca>'-s  are  detailed.  "  A  work  full  (-f  great  intcn-si       .      .      .      t!;e 

n    the    Mitiject     renders  mi'tlio.i    of    treatnn  nt     excellent.''—    H'«  x/iiiin  - 

•d  t.i  e\ -i  t\   articleisa|'peli  led  ft,  r  !,',>•'>•' 

::   \\    liiu^raphy  i-f  tiio   \\oiksand    papeis   con-  "  Stands  uni'ivallcd  for   eonijilt'ti.-ncss  of  in 
s    !r..i.                                                                                   formation \   really  practical   hand- 
le    tin.  Second  Portion,  the  arrangement  of  Imok. ''—>'.//«.'/./;•//  l{,>-i»-<l. 
T:.,    ii    /.i,,',    /'.-.'>•',  ,.s  i-  simplv  tliat  which  sutr-  "  Tlie  \vholc  work  is   full  of  useful  practical 

:     •     ralh    into   nict  imdical   inve^ti-  infm  malioti.  "  —  (7n  inictil  ^'ni'S. 
tin    n.oie  volati.i'   1'oisons,  those   that 

Hamilton,  Frank  Hastings,  A.M.,  M.D.,  LL.D., 


Till-:  IMMNt  Il'l.l'.s  AND  PIlAiTlrK  oF  S!  U(,Fl;V  llhistrati-.l  with  four  linn- 
di'.-d  and  sixtv  seven  i.nji-a\-iiiLr-  on  \vdud  (>:i.-  vn|  iiiin-,  I'oval  Svo,  II.") -4  jia^es. 
I'rii'e,  in  niiislin,  !<;.<'ti,  or  in  leatln-r,  S^.tm. 

"Has     evidently     bee']     prepare  1     with     t.l.e  "This    is    n    e    of    t]  e   Lest   text-books  upon 

Lot    i    on   the  pa;  t    of    thi       lut'lol  snr^er\    whicli   we  !.a\e  ever  see-i.  and   \\  e    rec- 

:    and  as  a  te\t    ' kt'iTt'-i-      < 'lid  it  highly  to  the  profes.sioii." — <7ii"i;/'> 

M      ,.•;••'••       tin     iil:di"-t    ere  lit    njio-i   its  .I/"-  '/-'•  n  '   I'',  j  •:  n    '.  >,•  r . 

v.-'  I     k       ...       :    i       itt.-d    wrier.       As    a    d-xl  "  1'rot'essor    Ham.lto-'s    latest    work    is   one 

1    .   k    '    •    the    -'ndi'iit.  o'-  on.     ol'   reference  for  that  will   add    t..    his   already  hiL'h    reputation. 

the  l.u-\  pr  ictitiotier.   it  undoul.te  il\   is  one  of  .      .      .      It    i,    fill    of    \alnalile    practical    sr[,'- 

th--    !••-•    a;.d    .,-...s/    iiioilirn   that    has  yet    ap-  u'e-,tions   and  .  i  n  e.-t:o:s.  "---.I  ///  <  rii-mi  Jniininl 

I  ...                         "           <l  l;,,;,r,l.  ,,f  n,,     \l,, !•,,,'  S,'\,  ,,.;s. 

"A    val'ia'.le    addition    to   our  li.-t    of  t -\;  ". \niericat]    i'i    plan,    scientifn-   in    method. 

.     •   wo.  k  of  reference,  a  ere  lit  wri:ten    in    cie  .r.    coneis.',     classical     Fni,'lish. 

•      ,  '  —  A"ii,       )'.  I';.;, :    Hau  ilton'-    Snr-er ,'  is  a  nol.le  le^'a  - 

cy    t.,    the    inedical    stmlent.    an    honor    to   t  he 

"I'  will  IM-  found                     ent  and  coinino;  [.rofessioii.    and    an    ornament     to    our    native 

.luine."— /."„./,,,(      IA-. /,,,/'    Tint'. •>    unil  toligPL-.'        /Jilrvit  Jt'fitir  uj' Jftlticillf. 
•   • 


Kcctlcy.  C.  B.,  F.R.C.S., 


alpha'oetii:al.  ai-d  tiietext  is  written  in    as  ele 

•'  :'      M     to  tin    ;••         _-ai:t    and     inli  i.i.ri  i.ie     IJi^lish    as    can    lie    ex- 

!'"/:.•-       'I'hi      pi    •  '.ii!']ei]«:itiiiiis  and    abridgments. "- 

•  u  !i:it  the  >y-tcm      /,';•  ',>',     I/.  ,//'•  ,,.'  J»»rn-tl. 
.1.  .  .          .  ild   ever  he,  imri  !\ 


1TULICATIONS  OF   WILLIAM    \\()()D  A   COMPANY 


Holmes'  System  of  Surgery. 


A  SYSTKM  OF  SKKdEUY,  THKORKTK'AL  AND  PRACTICAL.  1\  Tl:i.ATl>KS 
(>F  \  AKlol  s  ACTHOKS.      Kdit.-d  l.y  'I1.  U<>i.\n>,  M   D.Sur..-        i-ei  I.e. 

mi    Suruer\  ,    M.    C.eor^o's    Hospital,    and    Sur  ;.-.  >u   i  iH  hief    !"    tie-    M-  ; :  -.  .|...  i;..,'i 
I'.. lire.       Third    Ldith'ti.  1  h..r..n  _-li  1  y   r, -vi^-d.       Thr--o   vuliiin--.   upu 
paje.s         \\lth   numerous  WoodrtltS,    lit  ho _'raphs.   and   rh  n>ni"- 1  it  !.•  >.  Tal  -hs.       Pi      .  . 
i;i  nuir-liii,  $v!1.0u  ;   in  leather,  .*'.'  l.uo  ;    in  half  m,  .1 .  .L-,-, .,  .s-j  ;.IMI. 

•  k  i-  fully  up  tu  tin-  tiin.-s.  iiinl  f-nii>  :i  '  "  \\"liat"\  i-r  may  In-  thr  I'di-  f  i:i  tii.-  ii.:;-: 
in. .-t  cuiiiplru";  \vork  en  t;ir  tlifory  and  {irar-  :  t-nrc  nl1  initi-.-jisi>.'  i>.  uh.,1.-  ..i  in  |;ii;.  >\.: 
tier  of  suruC'-ry.  "—'t'/<triiji<i/!i<'  <iii~<  tt> .  i.m^rrs.sivi;  -.m  ^'roti  i.as  Irani,  ••!  tin-  \ai.i.  o'  t :. 

"  Ti:r  w.'i'k    as    a  \vi.o!,-.   rlaiin'.llL.'   a>  i      il.i.  s      rar.liiial   principles    ul'    rl.  anlitu  -.-..    I",-:,!  iii-i:. 
to  i  <  -pn-M'Mt  t  in-    I'.n^hsli   M1  lin ul   ut'  >  ur., ''I".',  is     [••rtliui.  aiul  ti  rr  lira '.  i  ax'1'.      In  '  ;•''  \  i.iuti.r  !• 
ci.:i:plrt'     in   r\rry   ri-spi-ct .  aii'l    really    stands     t'urr    \is   tnt-sr   |M'iiirii.!.-,  art-   dnlv    r..n-1-i-  i  •.-.  i 
viii.i.iit    :i  ri\al.      As   it    Man<U.    it   1'rpri  scuts     ami    the    (lili'rn-nt    ]...in!s    in   iiUputi-    a:  •   •, .  :  \ 
the  .irminal  anil  latent  llohiir.-' Sy.stt-ni  (.!' Sill'-     j.i(liriiii;-!\    p:.-«in.    I.       '1'ln-  .-atii.-  ina;.    l.e-a:i 
^  -l'v,   and    (.MPinailis    the   most    rrivut    views   ut'     i-rj.-iriiii:^  "t  In  r    .->iil.'.-ct-    i.l    (-41. al    i;up    r'a'.C'j 
tiie  many  ilit-tiiiiiui.-he  I  authors  who  tirst  con-  |  in    ti;.  ir    I'.-ann.;     iui     .Niiri^icul     operation. "- 
tribute. 1' to  ;u  pa-r.s."—  7'/<t  Jfttiu-n!  Ji<cor<L     ,  Jldii'-nl  2t«:<>rd. 

Clarke,  W.  Fairlie,  M.A.  and  M.B.,  Oxon.,  T.E.C.S., 

\    MANTAL   OK   STHCKRY.      A    n.-\v  «-.liti..n,  th.-r.-u-lily  n-vis-1.  M  i;l,    impor'ant 

:i'l'!iti.nis   l.v   an    Atnerieaii    sur-eoii       Neari\'    two    huii'li1.-.!    ill  u>tra;  i.  •:.-        '''.•: 
;iiM    j'a_.'S.       Sol.loiilv   I.'.'  >ul)Srrijitiou.       See  pa_e."ir. 

Wyetli,  John  A.,  M.D.,  Univ.  of  Louisville, 


KSSAYS    IN   St'ROICAT.    ANATOMY    AND   STiKJLRY        One    volume,    ^v...    "JtiO 

}>u_es.  illustrated,  inii.-din.      Price,  ^'.'.nil. 

A  JIANDP.oOK   OF   A1LDICAL   AND    SI'IK.ICAL    RI'.l-TiULM  Tl.       On-    voluiu.-, 
I^iao,  '„'?'.!  pau'es.  muslin.      Price,  Sl.^.")-.    tucks,  Sl.."»u. 


Bauer,  Louis,  M.D.,  M.R.C.S.,  Eng., 


I  »• 


LKCTTItKS  ON  OIITHOI'.KDIC  sriiOKUY.  I>.  liver. -1  at  the  I'.r.x.klyn  M.-iii-a! 
and  Siii'L-i.-al  Institute.  Iievi~ed  and  aiii'iuenied.  One  vnhnne.  ^v<i,  :;:!i',  j,a_-.  -, 
illustrated,  tnu-liii.  Price',  ^:J.'J."). 

'•  U'e    arc   .--pe'iall  v  pleaded  \\ith    the   rh.ip  o'ir    kiiowli  -l_'e    admits    of."— /'•''•//',-    .!/••/.     • 

ti-rs  on  di-ei.-cs  of   the    spine  and    joints  which  ./;/-/>/'/•,','''."'./'•'/,•;,,/'. 

o  ',-up\  a  la  ••'_:('  port  ion  of  t  lie  \,,,,  ,k.       Dr.   I  Saner          "  As  a  treatise   on  det'ormit  ies  \\ ,    have  \  e:  v 

h  is  had  cver\   opp'.rt  unit  \'  ot  :i<-.]naint  inur  him-  few  work  ~  to  compare  wi'  h   it .  -o  t  ::OM.  :>•!:  :.:;d 

sc.i   \vit  Ii  all  the  source-  of  infomiation    on  t.he  exhaustive  Iris  t  he   aut  h..r  n:  .•!•    i '  -  c,  ,i.~;^e;  a  - 

."•:!. ieet.   and    his  work   uill   he    found    as    nearly  tioll."-  ->'.    /.•"tin   .M-><".''   /.'-.. 
c.iv.ph  le  a-  the  present  ad\anced  co-iditioii  of 

Carnochan,  John  Murray,  M.D., 

A   TIM' \TISI;  OF  TIII:  I:TK>I,O<;Y,    I-ATIIOLOCV.    \M>  TKK\'|'MKNT  or 

CONCKMT  \l.    DISLOCATIONS  <>!•*  THK    Ili:\D    or     I'll.Ml '!;.       ir.u-.tiMt.-d 
l.y  lithographed   plat,  s       One   viilunie,  Sv,i.  'J:'."i  \   ,_-••.-,   nit^'i'i.       1'ri.-  .   f'.'.itii 


:M          ITDl/iCATIONS  OF    \\1LLIAM   WOOD  £   COMPANY. 

/'<f<  /'>/. 


Poulet.  Alfred,  M.D., 

--i-.ii  M.u    r.   Ii:*|H-i-t..r  "f  ih<-  Scho.il  f..r  Military  M.-.li.-inc-  nt  Vul  .VOn 


ATUKATISF,  (>N  FoKKKiN  I'.dl  >l  KS  I  N  ST  R(  i  ]»  '  AI.  I>UA<  T1<  'F.  Illustrated  l,y 
ori-in.ii  \viii'd-i-n_raviiii:s.  Translated  from  the  Fivn<  h.  Volumes  1.  and  II. 
.void  oiilv  1'V  su'o.-crii'tion.  Si  i1  J'a.,r  50. 


Taylor,  Charles  Fayette,  M.D., 


OX    Till:     .\IF.(  HAMt  AI,    TRKATMKXT    OF    DISKASH    OF  TIIK    IIII'-JOIXT. 
(>n<-  vohiine.  >vo,  C>'1  p:i--fes,  illustrated,  muslin.       Price.,  ,sl.vJ."i. 


Peugnet,  Eugene,  M.D., 


Tin:  NATfiiK  OF  <;rxsnoT  worxns  OF  TIIK  AP.DOMKX,  AND  TIIEIII 

n.'FAT.MFNT:    I'.as.d  on  a  Ileview  of  the   Case  of  the   late  James  Fisk.  Jr..  in 

Pilchcr,  Lewis  S.,  A.M.,  M.D., 

.   X.  V. 

Till:  TI!i:.\T.Mi:\T  OF  \VOrXnS.  V,,  in-  a  Treatise  on  the  Principles  upon  which 
the  Treatment  of  \Vomids  should  lie  Founded,  and  on  the  llest  .Methods  of  cur- 
i  .  in_'  them  iut"  Practic.'.  imdmliim  a  ( 'oiisideration  of  tin-  Aludilicatiuiiri  M'hii-li 
>pi-cial  hi'iirie.s  mav  demand.  IHiistrati-d  l>v  wouil-c'iiijraviiiirs. 

Saltcr,  S.  James  A.,  M.B.,  F.H.S., 

iiilu-r  ill  ]>.  iitnl  Sr.ixvry  MI  the  Collet;.'  ;    ln-ni:ii  S-.ir- 


DKNTAL    PATlloI.ociY    AM)    SUIOKUY.     One    volume,    Svo,    :U)(J    page.-,    illns- 
•      •     '  i.       I'riee.  s  !..>(). 


••:   «•:»<  i'"liii"iti-'l  H-*  a  surfji-nn.  an«l  luntr  '» -on  known  as  oiif  of  tho  most  scientific 

wa-II      -     >        •  UM  '.' Kiinr'sColl'-^eliosjiital.  ilt-nti^ts  nt'  the  <l:i  y.      M  r.  Suiter  had  the  irrcat 

i    tin1   tn~t    IIAV  vi-ars  a>  1\ •ant.'iLTcs  of  such  a  coinjilcte  niodii'al   I'lliii'a- 

i      ;~  l!i  it   h'    has  u'i\rn   lo  t:on    as    is    implied    \<\  tin-  possession  of    a  dr- 

,,.!••     tp-atisi-,  not.  only  ^rrc  of  tin1  I 'ni  vt-rsit  y  of  I>  mdun,  iipi.n  which 

on  i'.i    :                                     th  I'i.t  ;: ;-.  i  on  di -n  -  he  turned  his  attention  <.o  dental  subjects,  and 

i  ii  -MI  _'i  i  .  .      .     .      .      1  n  o  inr  his  ii  .11.  \M'  would  h','  has  continued  his  la' tors  ii  jion  tlio  ln'oad  t>a- 

ar.d  prai1-  >is    thus    laid    down,  "\vitli    the    satisfactory    rc- 

liinl  |iatl;oloiry.  Milts    that    he    has    con!  riluiti-d    not  a  little  to 

1'i'i!                                                                     in   a  Inith  the  scii  nee  and  practice  of  dentistry,  the 

•1    •!   a-id  i  !•   i   .:•  •     •                  :                I   i.  •  i.'.ul  l.\-  latter    in    its   widest    sense.      .      .       .       \Vc  close 

.llwiio:iri     nit.  i                       •                                  .,ut  Mr.   ,->;iiti  r's    work  well    satis!ii-d    that    it    is   an 

1   ••!'..       The    •  a  ii'Conl  of   ur 1    ]in\sii>lo;;ieal   and  |irai'- 

tic.il  work,  and  we  congratulate  lioth  the  siir- 

•         •         !•  nt     '.••    i  'l-i  ;ind  dental  I'l-olV-sii-n-  mi  jios-e-sin^  such 

:i   Milualjlc  \\ork  of  leferelici;."— Ao/a/'J/t    /.«/<- 

'I    .  '        '  !!.••     Vol'I!  '  ,  '  !'  '  •  .'. 

Goddard,  Paul  B.,  M.D.,  M.R.N.S.,  M.R.P.S., 


Till;  \XATnMY,  IMIY-Inl.oCY.  AM)  I'\TH<  >!.< )( ;  Y  Ol'  Til  K  11 1 '  M  A  X  TKKTII. 
Wi'h  tin  .M'  t  Iinjii  ,-.  d  M"t]p"i-  "f  Treatnu'iit.  iticlndiim  Ojierations,  and  tlie 
M-f!  :  '  Makin.-  and  S..ttih.  \rtiiieialT.-.-tli.  With  thirty  plates  Aided  in 
"•i  '  :  "  '  v  Ji»Ki'ii  i;.  I'AKKi.i;,  ])..-nti.--t.  Onu  vuhane,  4to,^'JT  patrt-', 
n.  .  l'i ;.  .-.  .<:;.  ,  ', 


PIBLK  ATIoNS  OF  WILLIAM    WOOD  \   COMPANY.          -J."i 

S>l  I'ljl  ft/,     />/•>'/  <l*i  X    <if      II    ill/I'll. 

Owen,  Professor  Richard, 

Till:  I'IMNVIPAI.  I-'OKMS  OF  THK  SKF.I.KToN  \\D  Till:  TFKTil  ^  a  I.,-  - 
I'm-  a  S\  ~t--lii  i't-  N.-itural  Hi-tnrv  and  <  'olnparat  i  v«-  \!,.tt»iuv.  t  n.  v./.uin--,  I'.']:..  . 
oi'l  {.;i_'i  .-.  iiluMnitcd,  cloth  Price.  ?."«.•. 

Tho  International  Encyclopaedia  of  Surgery, 

A    Sv-t.  inatic    Tr.-atir-e    nil    the    Theory    and      Practice     nl'     Sur.-i-rv.         ]'.:•    autie  : 
variou.-  nation.-.       Kdit.-d    \>\   ,l<>lt\   A-niii   U-l.  .1  I;  .    M    I  >. .    I  'i .  .ft-.--,  -i-   .,!'   (   ..:.  . 
Snrjerv    in  tin-  rniy-T.-ity  of    1  Vnn-y '  v:iiiia.       In  -is:   vi'liitne-    n-ya    k-\n.       I 
'rati-  I     \vitli    chroiao-litho_.'raphs     and     u  noil-.-i]_'r;iviiiL:-         Price     p.-r     •,•••!  ,:i.-. 
InUMill,    Sti.lMI;      Lather,    S7.0U;     half    UiiTuCCo,    S^.IKI.        >nl,l    ihly     I  _v     -i.i.. 
tion.       St-c  [.a_./  01. 

Munde,  Paul  F.,  M.D., 

I'rof.—  .r  .,f   (;VU.M-,.I.,_'V   nt    i1 


A   'n:.\'r-i;(")OK'   oi"   .Mi.\«>it   srncifAi.  (;v\i-;cni.o(;v.     r;n.-     ..:ii:i,.-.  ^ •,-... 

ii.-ar!v  (Jill)  paif'--,  il'iustrate'l  with  ov.-r  thr--.-  lur.i'lr.-'l   ••n_T,r.-;n_-.    i  -un-i    i:.  .  • 
tra  inii-iin.       I  'ri.-f,   So.UD. 

~u  ••    'hi'.    Mnid'-'s    Manual,  \viiii-h    ajipf-fii'i-il   a- unc  cf   ti.i-  vi.lniiif-   nf  t!.i-.-  r.iTnl  s.  ri>  -  1.1 

\\' !'•    Library  nf  St.'indanl  Mniioal   Autlmrs.  uii-t  \\itii   -uca  a  (••  .niial    i'.  .-,;,( i. .;..  an  i  i  \;.  ;. 

M\  .  •  .-  >!••.  t  !!at  tin-  1 1  i  Wishers  urr;mi{i''l  \vitn  l  h'-  ui-t  in_ui-h'  «1  a;ii  hur  !'•  ir  t  ;.<•  ;•!"  i ';.•!;.  .n  .1  a 
ill  i  u'tir  \V'.rk  whirh  wouM  In-  lins.^1  upnn  tiir  pivviir;-  nn.:.  iitnl  inci)r|.nratc  ;»:i  it-  lir--T  f.  a" - 
iii-f-  in  a  |iii'!"ii  t'i  .-iicJi  ntiirr  matter  as  woiil  I  \n-  tn-i-i---a  ry  i;i  c.  .!i-f.  ri.  nr,-  nf  ih.-  ;L'l\a:n-i-- 
T'.,r-ir  .if  t:;<-  -''i  -nr,'  ati'l  the  r<"['i  ircMicrt  -  nf  :t  Im.ik  -  .italic  for  ti'aciiin  ,r  ]'i;:]i  -.••>. 

'1'iir  \v.>rk  h-Ti1  anii'iuiu'O'l  i<  Tliu  rc-nlr.  aii'l  t  !;••  ]>ul-!i-l:ci-s  c.ini'il.-nt  l\  i  \j>i  ,-r  f,  r  it  ar  ni. 
•  •\  i  !:]>!>•'!  iMp[i:il:i!-!;y  in  its  tii-1'1.  'J'i»  surii  a-;  arc  i;nt  laiuiiiar  u  ith  tin-  p:  i".  io'is  u  <  >i  ,;:::• 
\  -'ili-ii.'rs  w.iiiM  .-ay,  in  explanation  of  the  snipi.-  a:nl  ciiara^ti-r  of  thi-.  ti.at  it  i-.  in:,  n.ii-.i  to 
IP-C  of  t:i'i>r  inii. or  torimit-a'.it  <• ;  aii'l  inanip:ilat  o1:-  cninnionly  cniployi  •!  int:,.  d  i  i  .:)•..  -is 
ii-i'l  tr.-atim-nt  of  dist.-i-i--  of  \vo:ni-n.  A-  th.-  .-i-op-i-f  a  work  w  iii'-i:  co\  cvs  1 1  <•  u  i  ..  ',•  \  a-t 
lit-M  of  _'ynn'o!o_;ii-al  M-i.-neo  doi--  not  prr:ii:t  t  !:i-  drtailnl  ili.-ciis-i  .11  ni  :n:i!'.;,  pra.'t.ru!  i  ..iiit-i 
\viii --;i  t:i.-  -tud-nt  an  I  praotitioiir:-  should  know,  and  is  o!.li.:--d  ro1-ar;i  witii  n.aiiv  :iiui..y- 
aii'1  •<  in  tin-  i  MM  I'M-  of  his  prart  ii'i-.  tins  work,  wlii  c  it  i>  imt  >upposi-d  to  -up;  !\  t  ::r  k;  "'.'.'.  !^  • 

trail,  i-  i  at  tin-  !>••  1-id •  op.-ratiiiLT  -taMo.    wdl  attempt  to  la\  lief  ore  tl.e  1 1  ade     a  e!<   .:   a::  i  .•>••.:- 

ci  — •  •(.•>•••  i[  a  ion  of  detail-  and  nrtnipulatioi:-.  tie  iur  no  ranee  of,  or  \vai;t,  of  ,-\|.i  ri-  nee  in  -A  ...  :i 
v.  :1:  oft  n  ].-ail  to  •  rrors  l.ot.i  of  omission  and  eoiiinii-- ion.  The  j.rofu-.-  i!!;:.-t  i'at  ion  nf  i:.-':  ;- 
in- -lit-  an  1  o[  i.  -rat  ion,  and  the  i  -a  reful  details  in  d.--enpt  ion.  \\  ill  render  t  lie  u  ork  •  v,  j  t  ••'.  illv 
v  .man].-  to  tlio-i-  ^'i\-in^  c-pr-i-i-il  attention  to  the  treat  :nrnt  of  di-ea — ;  nf  women,  and  iinl.-- 
fi--!i-.ilile  to  tnv  ue-neral  practitioner,  \vho  ran  inti:i-  form  o.ni\  avail  him.-1!  f  nf  t  i.  •'-;-•  :..'.- 
l-l.-'  i  xperi.-neo. 

Duncan,  J.  Mathews,  A.M.,  M  D.,  etc., 

i;:--r  ..!;  M:  \:\  :l'e-v  a:i  I    ]  »,- ,-,.-  ,  ,f  \V  ,.;  ,  ..  ;„..!  C      ;.;.••  n  :n  S::r.'.  •  •:.-'  H;.'!  M-  •';  .  a!  --•''.     -;:   '",:! 


A    PRACTICAL    TIIKATISK  <>\    PKRIMKTIMTIS    AND    I'AUA  M  r.TKITIS.       (>-..- 
\nlnine,    I'.'ni".  '_' 1'.  i    pa  ,-  -.  in  ii-lin  .      Price,  s1.'  oi  i. 

"  T:  o!,,:i_'h  a'lilit  \ .   power  of   LT- ttiiiLj  to  t!ie  '  I  iinu-an's      form.  ••      pu1  -lical  '-"is. '      _    )/"  ,,-'    ,t' 
liottntn    nf   Id,    >uli  ;,-.•(-.    ae'it"   eritiei-iii.    an  i      /V/,,,  ,s  ////./  ',,;   ,",. 
>-.Lref-il   oli-crvati.n   iniik    tn--    pru~.  nt,  as   Dr. 


Partridge,  Edward  L.,  M.D., 


Tin:  (»I:STI:TI:IC.\I,  KKMKMIUIANCKI:.     \  i,-  .;  :;-j;n..  m::ill,,..    p.-,,! 

trated     with     ininiatiii-c     u i-.  n  -ravin .---.        \V.  .-  :'-     1'.  ,  k-  t     .Ma'ina'..- 

Sl.UU. 


riT.UCATlONS  OK  WILLIAM  WOOD  &   COMPANY. 

J >ix,  i (si  N   nt    1 1  tin i'  n. 


Sims,  J.  Marion,  A.B.,  M.D., 

•      -\.-\\    >iu:il  '-  II   •--,'  • 


n.iNicAi.  NOTTS  ON  rTKiMNK  srucr.KY.    With  sj i:ii   n.-iVivmv  t.>  th.> 

Ma!i:ui  111    '  '   •••'  tin-  Si,  ri  ••  Condition.      <>nr  volum.-,  Svo,  -lul   i«:i'4i's,  i!  lustiati-i. 
|..-ij..-i        >;          .     !.'.:'.  ni.       I'l'i    .  .   si. 00. 

"II      is    nri  'in'i-]it  inn.  ]"  rs.'vcrir.^'  t'vi-ry  j'ructitiiiiiiT,  yinui^;   and   old.      Wliili    its 

•'         •  .        ,  .  ni  ilui-tiun,  ainl  tiMi-hii!'.:-  ap-   sn   simpli    liiat  tin-   men-.--!  tyi.) 

'      • -.-•  il.-\  i-l,  •]>-  can    fully  ciiin]irclu-iiil    ttitiii,    tii'-yari1    n-pk-ti1 

•     •    •  iia.-  In    it   ;i    stiunliMiiLr-  with  viilualiU-  I'-ssnns  to  tin- jiliysioiaii   «(   liju- 

:,     •                                                          .                           \\'t-     folll  l-xpi  ]'ir]].-r.        \V.-    l:a\i-    ]»ru-i-ii     I  i .  i-   \>  i  ' :  k    W  it  ll 

—  \i    •    <i,--  lunch    .-:il  isf'aciioit,    ati-:i,_r    li-nin    it    n-l'ivMt.-d 

:                             >•      •  •        '  .'    •.,-•'<:'.  ratin-r  tlian  s.'tt.rd."  —  l'n<\tii    J/'  <H  a  I.  u  id  S»r- 

••Th      .    U:n..    f\i<       i    U-   in    tli,'    hands    of  <ji>;ilJ<>".i- 


Skonc,  Alexander.  J.  C.,  M.D., 


DISKASKS  i»r  'nii;   r.i. ADDI-III  AND  rur/niiiA   IN  \VOMI;\.    Ono  voium-, 

Ss-n,   117-1   |i:i    •'-.   illu~trat''d.  inu>Iin.  Pnrr.   s:!.(n). 

"  In  uddiiinii  tn  t:n    -!•  ;\i:.  .  pi  ;,rl  ;>-:i!  inattrr  "  I  >r.  Skriir   has   ri'inlri'i'd   tin'    profi->.-ioii    a 

i:t   wl:ii-ii    Cii-'Wiirk   ai'mnni.-.  \\v   i.avi-tln-  .id-  n-al  M-rvicr.  wliihrtlu-   jiu'a.uri-  illfo]  nuitioii   nn 

•,     '.'._',     'i     i,.    -tr;it  imiK    adiiiiral.lv   i  xefiitt  d,  1,'iis   sulijri-t    ln-n  t"l"t  f   \\itliia    tin-    narii    of 

n    ihr  L-liajitcr  el!    urinary   aiialy-  Imsy  j'rartitiiiiicrs  \\  ni  i-niiiniaiid  for  this  Imck 

/         •    •      <•'•/,<,,,/.  im/i'la,-.-  it   .-liould  tdl    in    every  lil.niry. "—>'(!. 

'T         .'     rk  nl    tin;  ili-tiniiiiishi-l  jjyJii-c-ol..-  l.i.'i'o.  .\f,,li.  n' nml  Snr;ii.  ,il  ji>nr,,,i! .' 

••         •    •-    in    ini'dii   i]    l.t,  ratur,-.       It  "  Tlu-si.-  li-i-tun;s  an;  t.-.\;u-t.i\  u  hal  tin-  atithur 

n-d    tin    dtilv   Bvst.i'tuatic1   trt-ati-i1  claims  for  tin-in      a   i-oiivniirut.,  (-lain,   iiiirnni 

i-'-i  in  tli.-  1;]      :                    a_u-r,  and  plicated  ;-tat,  im-nt  of  tin- iiriiK-i|)al  iiisi-ascs  of 

i..     haili-d  \\ith  the    innalu    uicthia    and    1'ludili.r." —  J'-tr'-nl 

;  •   -'  --imi  thri  n^  in  nit  tin.-  ci  mil  try."  l.mti'it. 

'  •  •  M..I: 


Bedford.  Gunning  S  .  A.M.,  M.D., 


•  \Vi     coii^ratulati'    the    author    upon 

'                         '"    i  !  !ii- l.i_rh  rornpiinirnr  paid  t"    Id-  lalmf--  in  1  hi- 

•    '          :      It"     hi-  -'i.:    ii'-w  fi.  Id    ,,f   uterine  path, i]o;,f.v,   wlierr   >o 

.     •  .      •          '.••  \  ainl\  f'.r  f'  p'itai  ion. "  ---  .!»/,••  r- 

•                •  -  i.-,,.,  M.,J.  „•  T.,,U*: 


G.irrii^ucs.  Henry  Jacques,  A.M.,  M.D., 


-   I 


PUBLICATIONS  OF  WILLIAM   WOOD  \  COMPANY. 
2Jia<-axfx   <)f   \\  oin<  il. 

Verrier,  E.,  M.D. 

PRACTICAL   .MANUAL  OF  OP.STFTKICS.      Fourth  edition.  .-nlai  _---d  a:,-!  r.-vi-,   i 
with  four  Oli.stetru;  Tables  of  ProtV.--or  Pujot.      Fir-t  American   edition.  w::h  j. 
vi.-ion  and  annotations  by  Ki>\\  ,\i;i>  1..  1  '.\  i;Ti:i  i  ><  .K.  -M  1)..  I'r..:.  ---!  ..:  •  il-.-t.-ti  i.  - 
in   tin-    New  York  I'ust-t  .raduate  .Medical  Sclio.il.      One  volume.  "v.  -1'jn  !•;..:•- 
illu-trat'-d    l>v  one    hundr.-d    :in.  I    livi     \v.ik/.l-,.ii_'r;ivin_;- 
Suld  l.iv  subscription  only.      See    pau'e  ">•.*. 

Braun,  Dr.  Carl  R., 

I'riifrs.-or  of  MiiUvift-ry.  Virnna. 

THI:    rii.KMK;    CONVULSIONS    or    I>RI;<;NA\(  v.    i-AHTrurnoN,    AND 

C11ILDUKI).  'I'r.-ui-httc.l  IV,  .m  tl.c  (.crin;ui,  with  in-ti-.-i.  l>v  .1.  .M  A  I  Til  i:  w>  Di  N 
(AN,  F.It.C.r.H..  Lecturer  on  MMwilVrv,  .-tc.  On,-  volume.  I'.'in.'.  !^'J  p;i_-.- 
iiuislin.  J'rii'c,  ^l.Ul). 


'•  It  contains,  in  u  condensed  form,  tho  iiii>st     perusal."—  >Y.    l.nu', 
f.i:ii]ilete  ;ind  n-liaUe  liistorv  ill   this  afi'i-i.-t  inn     Jnnrn-i'. 

yet  {.iil.lisln-d."—  A"-  ('•    Yurk"  Journal  vj  .Will-         "A     most     v;ilii:i))lc    essay,    an.l     c.ne     t'::r 

wili  not  In-  riisilv  rivalled  t'.>r  it^   conipk  !•  i:-  >- 

•'\Ve    iidvist-   all  win)   feel    intercMte.l    ill    the     aud  erudition."  —  lJ,i>,!lt,    .I/-  ./:.„>  /',;  ,x. 
subi.'ft  t(i  juvcure  it,  as  it  will   fully  repay  the  . 


Byford,  William  H.,  A.M.,  M.D., 


A  TIIKATISK    ON    TIIK    'I'HKOllV    AND    PI!  A(  'TI(  i:  oF  OI5STKTIIICS.      Ulii- 

trat.e.l    with    one    hmnlre.1   and    lii'ty  wooil-u-iitrraviiiL's,      On.-    Volume,    Svn,    -iii'.i 

]'a_'es.  mii-lin.      I'rice.  s.",.  7-1. 

"  i'r'iiVssor  JSyfcird  ha^  ln-i-n  lnn^  a:id  favnr-  art  in  the  mu>t  availnKie  i'nrm      It  i-  i-MinpK-t.-. 

a:il\   kii'iwn   tn   the   prnt'e.-sii)iial    pul.lic   liy  his  tlioir.rh   imt    l'ir;:e  ;    it    is   full   and    pen.  et.  an  i 

l'.u:::ei'<i'is     coinmunications     to     the     medical  .-till    is   ci.iniir.'S^,.  1    int'.   comparai  :  \  .  ;\     Miidi 

jiri-s-..  iiis  previously  pnlilishcd  i  laliorate  tnioks.  .-pace       It  c,.nt;iin-  \vlrit    i-  knou  n.  and    coin 

u::d   hy  lii>   widely   extcndi-  i   ]>rivate  and   con-  mends  itself  to   tin-   prnt'i  SM<>M.  and   e-p'C;:ii:\ 

s'dtative  practice.     .     .     .      Professor  Jiyford's  tn    medical    students.    l.\    iti    pt-dn.    wc!i-c,.n 

h.n.l-:   i-  I'ully  ii]i  to  the  times,  and  a  succi-ssfal  -ideivd.    coniplet.'  teachings.     Iv.  •••rythin,'  t  ir;t 

t.'\pM-ition    d(    the  .-uliject."  —  <  'liii-iiij,,  .][i<lif:il  can  lie  said  in  t'av.ir  d'  ;.nv  wnrk   on  this   .-;:!. 

./..  .'/•-,,;/.  jectcail   be  K.lld.il    It    "  —  Jj'njf'.l!u   M"iu'll   ./-/..'- 

••  1!;.  l.u-d's  Olistftric-iatlords  tliestudein  and  '/fit. 
jiract.rioncr     the    si'ieiicij   and      ractice  ot'   tiie 


Klob,  Julius  M.,  M.D., 


PATHOLOGICAL  ANATOMY  of^  Till-;  FKMALi;  SEXTAL  OIIC.VNS.  Trans- 
lated  from  tie-  (  ;,.|  -man  liv  .d  i«.i;i'ii  K  \  \l  M  I  .  Kl  •:  i;,  .M.D.  I'l:  \  .-i.-ian  to  the  (  i.  -i  -in.  in 
ll.ispital  and  I  )i-  p.-.-.  -ar  y.  N,-u  Voi  k  :  and  P.KN.MMIN  I''  D\\\-<>N,  M.D.,  A- 

.-i-tant  to  the  (  'hair  ,,f  Oh.vtet  rics  in  the  Co!  l.--e  of  1  'h  v-ician-  and   Surgeons.  N'.-w 
^  oik.      (>ne  \-oliime,  svo,  •,".)'.  i  jia.'es.  mii-iin.      Price,  s:!..")(i. 

Chapman,  Edwin  Nesbit,  M.D., 

I.:it.  •  !Y..f.--.,r  '.f  Di,-i.  •-]••-.   Ij;,.  .,-,.-    ..f   \V..;n.  :i    n:i.l    C::iMi.-i. 


PI  PLICATIONS  OF  WILLIAM   \VOOO  \-  COMPANY. 
/>/.«.vf/,srx  of  Women. 


Emmet,  Thomas  Addis,  M.D., 

VESICO-YACINAL  FISTU.A  Flto.M  I'AKTC  H  ITloN  AND  OTHER  CAUSES; 
ui:h  Case-;  of  llei'to  vaginal  Fistula.  Illustrated  with  svood-engriivings.  One 
volume,  SVM,  -.'.Mi  i.aje>.  muslin.  I'rire,  ji'J.75. 

\      ireful  and  i>am>takim,' record  of  many         '' No  work  of  its  si/o  has  BO  much  enriched 
i  a-i  ••  '  I   \iMcn  \a_''l  ia!  ti>ti:l.i.  arising  I'mniall     tile    literatni'e   nf   gyiU'Cology   as   this    one."— 
•    n|.e|-ations   in  ce^^arv  in     Muliriil  /,', , -«r<l. 

v    lie..,,']  .\f,<!i,,il        "As    to    tin-   j,/,i/xi</n>    of    the   hook,  if  we 

have  any  fault  lo  lind,  it,   is  with   the  elegance 


Brown,  W.  Symington,  M.D., 

M.::.          fihi   liyiKi      '    .•   ••          ii-t\  ni  li.-t.iii:  Fi'llow  of  tho  Massarhnsptts  Modion.1  Society,  otc. 

A   i  LINICAL    I!  \NDP,(ioK   ON   Till".    DISEASI-'.S  OF   WOMEN.       Illustrated   with 
tc  volume,  Svo,  'J-l?  jia.'e.-..  mu-lin.      Price,  S'J.5l). 


1'  •      •    wnt.-s  -.vith    irreat    simjilii'it  v  i  a  master  nf  his  subject,  and  chooses,  off-hand, 

•  -t  \  le  in  ue  ii  re^eiu  ill  in::  thai  ( i  f  a  •  the  shortest  route  to  the'  understanding  of  his 


Tilt.  Edward  John,  M.D. 

\    I!  \.\DllouK   OF   FTEHINE  TH EI1APEUTICS  AND  DISEASES  OF  WOMEN. 


Tait,  Lawson,  M.D. 


Fritsch.  Hcinrich,  M.D., 

•      >iul      .    li-ni.-:   :it  the  University  ..f    I!:,  li  . 

Tlir.    DiSE\S|-:s   OF    \V<».MEN.       \    Manual    for    I'hysiriaiis   and    Students.       Trans- 
I    iimiii:    Fi  i:vr.      I!   u-trate,|    with    one    hundred    and    fifty  tine  wood  - 
•       .       Sni  1  (inly  l>y  suhM-rijitinii.      Sec  |I:IL.'I-  ,"»;{. 

Savage.  Henry,  M.D., 

•     -   .'    •  •      :       <.f  Kncl.TM.!,    i.JH'  i,f  the  Ccill--nltillK    Moilieill   (  HTleCT.-    fif    t!,(j    Sa- 
II..::' 

THE    <i  ii'ir.nv.  sn;i;icAL  PATIIOEOCY.  AND  SFRCICAL  ANATOMY  OF 

Till;    FE.MM.i;    I'EI.VIC   OIKiANS,    in   a   Series   of    I'lates    taken  from  Nature, 
«i'h    (  "iiniv.1  M  i.  -.    .N.ites   and    Cases.      Tliird    fMitiou,  revise,  I   and  u'reatly  cx- 

t'  lid'  d.        >,.;   1  ihsei'ij.tioll.        See   ],;iue    5(1. 

Hart.  D.  Berry,  M.D., 

••  •'•  r;.  •••.  MI-.  '  '•','   •  ,         f  -•,   if,  ;,.,.,  iMintmreh.  fto.,  etc.;  nn-1 

Barbour,  A.  H..  M.D.. 

;        '  :    !     .    •        .•   ".. 

M\M    \l.   iiF   liYNKCOLnc.Y.      \       ,:        [        I   !u>lrate,l    with    ei.-l.t    j.hiti.'P,  two   of 

ii<-ty-two   line    \vood-en_'raviiiL's. 


PUULICATIOXS  OF   NYILLIAM   WOO])  A   CO.MI'ANV 


West,  Charles,  M.D. 

HOW   To   NTRSF,  SK'K  <  'II  I  LDKKN  :    Inten.l.-,!  .-p.-eial!  y  a-  a  H.-lj.  t  >;  i,.  •  N  ur- 

at  tii>-  lln-pital  !'•'!•  Sick  (  hil'lr.-li  ;  Lut  c.  -nlai  II  i  li  _T  'lire,-;  ;,  .;;-  !h  i-  iu,i-,  )...  |..iji,  1 
of  service  l.i  all  \\lm  have  the  char.'-  of  the  yn'.uu'.  Uin-  volume.  i'-tno,  m:,- 
lin.  I'rice.  ~>i:v. 


Smith,  Eustace,  M.D., 


A  PR ArTirAh  TRKATISK  <>\  DISKVSI;  ix  CHILDRKX.    on.- *vi>  voium-, -•>-; 

j.H.'os.      Price,  in  cloth,  so. 00:    in  leather,  si:. MO. 

••  N'n  Hi'  -ilical  v.  Til    r  has  writ  tell  -o  well  upon  hance    its   |ir;ictic;il  \vnrtll.      The   sc.lijcets  e,  >i, 

the  \va-tin-.;  il'.-ea-  -  "t   eiiiiiireii  a.-   Dr.   M:iU.i.  -hieiei    ;ir.-  :-- Simple     A'n>p;,y     fin:::    It:-i,!:: 

These  alVecti-n'.s  are  c\cee<liii'.rly  common,  an. I  e.t.-nt  Nnur.  -i:inent     •(  'li:  <  <i:  ie  Dia:  Tinea,  ( 'h  :  •  •  :. 

often  I'.-itMe  tiie  hot  efforts  ot'  tin'  piiy.-iciaii.  ie      Vomiting      I  tick' -I  -  --  In  he  rite  1     S\  phili- 

'  •  hi  p  ••paring  a  t  mirth  e'i:t:..n  nt'  I  hi-  wnrk  Wnr-.-i-     -'  ':•.<'•  >i:  ie  l'u,m<-ua:  \  1'i.' !-.  i-is      (  'a-  ^ 

f,,!    t:.''    pi'' .-s,  tlie    text,  has    IIC.-M    f-\  i~ecl   ;iii.i  !"••   ni'    l.\  mpiiat  :r  <  i  iaii' l>      Da:    "I    <   ii.i'h-n 

jnan  v  ait'-r:it  ;uiis  tin  i   mliiitimis    have   liceii  in-  in  i  I'-ait  h  IUH  I  I  >i-<  a-e.        Smne  ri  \  ie\v.  rs  h.\\ , • 

tiixlii'-'-il.        lv>e|-y    care,     liciwever,     has     I)IT:I  criticis.il    tie:   i-:.a|it.T   HM    .ii.  t    a-  lu-in/  ' '  t  ».> 

t  L!."".  T.'   niaiiit:ii:i    i  he    practical    ehara-'ti-r  m  cl.-itinnite  "  '-it    \v.-    cun-ii!.-:-    it     i.    t    eia!e.ra'e 

tu.    '..,ik.  -.tiiat  it    ma\   continue  to  lie  a  sal'e  lmt  c^mplet. •."—'';,;,-,,,/,,  J/:  ,/„,,/   /',/„..-..  I  ;.;•., 

^  ,'d.-  t"  :  i.e  management  of  -onie  »]'   tlv-   c'.m-  lvv">. 

Ii!"!:i-:,  '.;it    imt    ti.e    lea-t     tatal.  mnhiilifs   of         ''The  author   i-  a  cl.-ar.  conei-e  \\ritcr.  an  1 

ca:i\     life.        l-;\erv    jiliv.-iciaii    shoni'i    have    a.  l.-ave-   no   ilmilit    a!>":;t    t!a     iiiia   !.••  !:• !'••<.-  i<> 

(MM-,    of  riii-  \v,.rk  in   hi-  hl>rar\ ." — "/'//'    '',,,,  •;,,.  c..nvey.      ( )ne  of  t  he  Timi't   \  ai-;al  ie  cnat't--!  -  i;; 

•:    \l~., i;,.,'  .\'  '-.s,  June,  1  ^:>.  i:ie  h.'ok  is  tnat  'ipon  inhi-rit...i  -\tiiiii;-.     '\'..~ 

"  I)  a'.inj    \vith    a   c,  .mpr<-h'  nsi ve    Lrro:ip    ot  (ii-i-:isi>  i-  so  jin".  ah-nt,  an-i  e-jieciallN    ini-i:ii->. 

di.-.-a.-'-s   clniM''t"ri/--il    l>y  \\a-tiie_'.   it    hee,  ,jn,'--  tiiat   a  fu.i  ii:seiiw.-loii  i.f   t;ii,^    .-ul^ec!    i>   at    a.! 

ru:  inva'.nal)!e  aiil    t  >   ili'e_'ti"-is   in    tn.  >e  ot't'-r.  ti.ue-,  vahiai'le. 

ohsc'.ae  leases.       h   is  especial  i  v  valual  >le  1"  the          "  I  )r.  Sm.i  ii  has  spnk'-n  in  siich  la::^  i;a.T  •  a^ 

practi1 1>  .ner  in  iaru'1-  citie.-,  or  p.-r'naps  \ve  mu'ht  To  leave  no  mi>tak-    a  hunt  the  .iia_'n.  -i-  ..i    ::  •• 

more  tra!\    .-ay  tn  the  practitioner  wh  'revr  ; •<•  iti.-e;i.-o,  an  i    t::i-    ;.-   a    ]  r.int    \viiieii    cani.ifl    :. 

ii.;i-.'  In-   !oc:iiivl.  \vho   lia-    t"   ileal    \v'tn    inf:it. i  overe.-'  i-nat  eil,    a-    '!.•     liitiiciilty  nf    n.--...  n  ;   a 

c  m-ti;  :itinn-  \vhii-h  have  lu-i-n  \vrec'i:e  i  !.y  cit  y  'i;auii"-i-   of    the    i,i-  a--    is    often    vei\    ;'i-   .:. 

In-        '[':.•  '. Ic    is  full  of  ;,-,il|..iiii:lry  int'or;n:i  .      .      .      Th'-re  i-  nn  Let  tcr  Imok  of  t  h--  1.  ir,,  •  i'l 

tin:,,    an  i.     'i'-a':in_f    as    it     iln---,    with    ill-  -a-e-  1  hi;  IviL.'lis!i  lan-.rna'je.  a:i-i  \v  e  a-l\  i--- oi;;   •' 

ciri:  ,e''.  -:  i/.,  ••  l    l-iru",'lv    In'    ii;al-nn;  fit  ion.    c  -n  t,,   proee.re    it    at   -,nc--.  a~it   i<  te.il'.  ;i',;-,  .-:    , 

tjiit:  -    '.'-.'•    ;  no-it    cavi  f 'ii  I  v   claliopi*'-'  i    a'i'i    sc.c  1  ;.e   time-   ;iM<l  ;l  nm-t   va  ina '  >'.<•  coi.  t ;  :  I '  : :  ii  :     '  o 

c.  — fnliv    t,--e|     -\st,-ms    nf     f,'.  .iinvr."       /'•'-•  a    lil-rary."      '/'/,,     .I/:,/;.,'    //,-,-•,;.   I,,  ,-;.-v::i--. 

'/•'.  '       >,.>..!'.,     Detroit,      Mich'.,     ,]„!-.-.  Kv  .   July,    is-.'.. 

I  *•-.">.  "The     L';r-'at     impiin:i:;i-e     ,  .f     t!i"     sii.l'iivl 

••'I'i.i-    is   a   -t;lM,  !;,,•>!    work.      ...      It    i-  treat-. I.  the   s.niml    unljmei-!    .-\i  i1  ..t.-.i  r.  t '    • 

tiie       .    k  t  .  w:;ieh    the  ;mthor   o\v---.  i;:  a  !ar-_'-  iiire.-t  inn.-,  a-  to   tn-itmi  nt.  a'.i'i    tin     c!  ;u  :  ,:i  j 

l:..  :  -  :-t  .  i:i- _'i  eat  repeta' I'-u  in  p'-iiat  r-je  m.  ,):  --\i.    .  if  writ  mi: .  re!i.  ier  it .  in    our    npiti'i    M.  ;i., 

ri    •     .ui-1    if    :.••    i.a'l    \viifen    no   other,  wm    i  m"-r    inti-re-tire;   an-i    n--.  p.l  i,,,  ,L  nt    "    e  '^  •.  : 

i:'  •    !1    -\:l:e:    -.'.T    t,  ,-,;.,;,,,,  I    1;,-  f', III,'.        .        .       ,  t     l  '1 1     h  -i  s  ,.\  ,  •  l-   t  lee  1 1   T  e  ;  i  ,1  ;  -  !l ,    ,  i .    '  /  ',        I., 

:,:    .  •  nf  \:.  _;    ]-.•'.  at  •  \-,-    to    t     ,     ;   ,t   ..,''       \  ar.  •  .  v  -,  pt  i-  ,nai!v   rieii    ::.    \  ale-      !  --\  •;    . 

-•nrv  o!    th"   alTect  inns   nam,    i  i-  ill  a\\  n    lY"'       a    '.'.el,     a:>j    mr-  i 

:      '  ..-        r   .1!     ijiii  -t  ion     oi     i'i  ill-1  r'icl  ive  :r :  t    e\  pi  rier.  ,•--."     -  /  ;,  •      A  .'  -.','. 

t'.-  ;;'ic-      i-      ii.    pt    eve]-      in      the      f,  n-e_'l  ,  ,,]  n,  j.  /,.,-.'!,.      \  i._  i;  -r.     i  --."i. 

:,-.  :     oi    e      -  ii     in    all     i'  -     I-  arir,_--    aft-  r    the          "  .       .      .       t  nl!  uf  fact  -  (••  !  t  •    :  :•.  _•  T .  i  t :  .••  I  .' 

n   i  •    who  has  ma.-rer.-il  t  hN   uitficnh  e-t    ,|,.\ ,  i  .p:-,,  n  t    of    ;hi-    (...; 

tl  .     i'.t'intile     me.hi'iv.e."       /.""••    :    •  ;,!i    (.Vf-r.---    .    h.    t::-     '.:-,-._     .  '    a    :       -•    : 

' 


Ellis,  Edward,  M.D. 


:;o       ri  INDICATIONS  or  \\ILLIAM  \voon  &  COMPANY. 

/>/.s>  r/.sv  x  df  (Jhil'li'tn,   <>f  tfi<:   Ky<  *    A 
Hcnoch,  Dr.  Edward, 


l.T.i  TriM'.S  ON    1HSKASKS  OF  riHUHlKX.       A    Handbook    for    Physicians    and 

Mud.  nt-       Tiaii-dat.-d    I'ri'iti    tii.-    (M'Miian.      Sold    onlv    bv    subscription.        See 
1,1,,-  M. 

Routh,  C.  H.  F.,  M.D. 

!\F\\T  FF.FIHM:.   \M>  ITS  INFLFKNCK  ox  LIFK-.  r.r,  Tin-  Causes  ami  PI«- 

veiiti.'li  i  •!'  InfaiM    M.  ''  ility.     Third   Kdition.     This  mii<|iie  work  forms  a  volume 
ct'  ','sii  pajes  iii  \\'i'''>i's  I.:!  T.'ti'v.     S.'M  uiilv  l>v  siili-crijitinn.     Sec  pairo  57. 

Dwight,  Thomas,  A.M.,  M.D., 

iiynn,]    !Ii-i..1,,,.'y  in    II.'irv:ir,l    Tniv.-rsity  :    FdlfW  nf   tlio  Anu-ri-i.n 
A.-:i  'i-Miy  "I    '  .-••-.    S;iiV"li  at  the  ('nriii'y  ll<ir>|iital. 

1  i;n/i;\    Si;i  TIitNS   <»!•'   A   C1II1,I).       I''it'ti-t'n    full-pairc-   lithotrrajiliic   jilatcs,  draw- 
•    l.y   II.    1'.    •.M'lNcv.    M.l>.      Our    volume,    royal   J^vo,  l>(5   pages, 
Price,  S:;.IKI. 

•    'I'    i-  !.,  ok  pns-i'-«i  •-  tin-  LTi'':it  merit  iinwa-  t,rans  are  no  lunu'er  tliosf  of  an  infant,  and  not 

liny-*  .  t'  nri^in  .  es  are  jien  draw-  yet    tlio<.-    of    an    adult.      The    sections     frum 

,:._•,;;    in  >•  c;  j..vi  of  the  liody  of  a  ^irl  said  to  which   these   drawings   are  mado  begin   at   the 

i!n    .      ..     :  1.  .      1    at       beautifully  and  neck,    and    continue,    about    and    inch    apart, 

''          po 


Mauthner,  Ludwig, 

.    ;  •     .     ,  .;•  ,  \  (I..-  Piiiver-ity  ef  Vic-inin. 

Till;  SYMrATIIKTIC  DTSRASKS  OF  THE  KYI'.  Tran.-lated  from  flu-  Herman 
Iv  \VM:KI-;N  \\'i-:i:vrr:i:,  M.D.,  Sur-e<m  Fniti-d  States  Army,  and  JAMKS  A. 
Si'\i  I  HIM.,  M  !».,  M'-nii,.  r  ,,!'  tin-  American  Ophthalinoloeii-al  Soeietv  ; 
Oj.!,'l  '•  .,:  •  Sur  •  m  to  the  Maine  (Jeneral  lli^pital.  Oil...  volume,  1'Jmo,  '2^0 
j,a  .  i  I'rice,  f.'.iHi. 


:     ••  Mpiit  h;ilmia,    so   that   the\-  may  at  once   rceoi;- 

•  •     i        I    :  .  '  '  •    •  .  •      ni/.-  it-  presence,  and  treat   it   from    tin-   outvt 

appr.'pi  iatcly  and  etli-ct  nally.     All  houtrh  ca-i  s 

M1.     i    )        •       '    •    .'     •••:.•..  ire.    must     of   tin-;    nature   are   comjiaratively    rare,    then 

rtani-e  U  sutlici'-ntly  ureat  to  account   I.  .- 

:;:'r\.  In      the   appearance  of  this   excellent  work   in    an 

.iici    n:i\  \     :   •    l.a    •     ;i  .         k-:n    and     l^iuiish  version." 


Noycs,  Henry  D.,  M.D., 


Foolc.  John,  M.D., 


PUBLICATIONS  OF   WILLIAM    Wool)  ,v   COMPANY.          -".  1 

I>ix,-ttx,  .y     of    tin'      A'//'  . 

Stellwag  (von  Canon1,  Dr.  Carl, 

I'r  .f. --.-a-  -,f  >  >|.hth.i!m.']  •„•;.  in  th,>  Iini..-1-.al  il.  ;. :\l  Uiiiv.-r-i:y  •  f  Vi,-:.:iii. 

TRFVnsi;  OX  TMH  IHSF.VSFS  or  THF  FYF.  I  \<  'I.r  I  >I  M ;  THF.  \\AToMY 
ol-'  I'll  i:  ( >ll<IA\  Trail.-!  at.-.  I  t'r.>m  tin-  I'inirtli  ti.-riirni  •  •  i  ;:<>n.  an  i  .-  ii-.  !  I.-.- 
I).  11.  ST.  .Inll.N  Il(t(»\.  .M.D.,  <  lilliral  I'r.,f,-.-.-.-l'  i.:'  tin  l>i-.-  -  ..!'  tii.'  K\.-  aii-l 
Kar  in  th.-  I' niv.  r.-ity  uf  tin- t 'ity  of  Nc\v  Ynrk  :  Snr_.-.  .;i  :•.  r  i,.  Manhattan  K\,- 
ami  Far  Ho.-pita!  :  t'll  \KII.~  S.  UII.L.  .\i  I  >.,  fi.nm-r'.y  A.--:-:ant  >,;!•_'••• .;,  t.>  th- 
.Manh  ittail  Ky>-  :ui  1  Far  Hnspital  ;  Clini.'al  .V-;-talit  in  tin-  N .  \v  Y..rk  Fy.-  ah  i 

F:<r  I  nlirmarv,  ftc1.  :    an  I  < ')!  \  i;[  l>  I',.   1 1  \.  K  1.1  •>  .  M.  I  >..<'! in  i.-.:!   I'r..'' r  ,  •!'  !',-• 

I>:.-.-a.-vs  of  the  Ky,.  an.l   K:ir  in  tin-  \Vi. man's    M.-liral  P.. 11. ......   ..f   tin-    \  •  ••'.    Y-;k 

I  ntinnarv  ;  Sur_'.'..n  l<>  th--  N.'\v  Y"rh  ]'.'•••  an.l  Far  1  n:ii  mar^  .  O;,.  v..'.i;iii", 
Sin  [..-rial  ^s'.i,  !U."i  j.  a  _".->.  ill  n.-Trat.-.!  I.-,-  v,'  n«<l-i-n_'r;i\  hrj~  an.l  rur.'i::  ••!/.!,.._:.:;.!..-. 
I'rir.'.  muslin,  if"),  nil;  Irath.-r.  si'.iiii. 

"  !•   -!.(.' 1 1. 1  In-  in  tii.'  !i:iii.ls  ni'  e  \-.-r\-  in.-.iii-al  1-  .  n  JI:I.-M  •!  snri'<--s!'ul!v  :   aii'i  th.'   tr:ii^iar..rs 

iiiai;.  an  i  n<.  (.!!'•  C;IM   >-it'.-!\   pr.u-M-r  c.piiti.ai  ar.-    i'nil\    ju.-.;  n.<  -1    in    .-ai.in,'   r   'a    ;.-x!   :...•. ^ 

in  .l.ijv  wiiu  iii«'.s  nut  ii-^anl  thi1   si:l iji-t-t    i'n  :u  u  i.i.'ii    i^    i.-_;ar.i.  .1    jis   m..1    .  t'    t  !.-•!..-•  i :.;;;•• 

a  ~t  iii'lp'.i'  t  at  ii-a.-t.  a-  l)i^';i  a-  St.'lhva.,'  nci'ii-  '  '••  nnan    '.'iii^:ia_'-'.'      It    •!•  ;i!s    l"..i!v  ana   ii>-.-;;- 

j.i.  s. "      \'  "•    }'"/•':  M-  ii''<;i/  .luiii-ii-i*.  riii-!y    \\it::    .•%.!•.-    i.r;ui''n    .  •!'    !;.••   s-ul.ji-.-t  i.i 

11  Tiii-  i-*  i-lH1  nf    t  inis.-  ri.iiU'I.'tt1.  i-xhaiist  iv.1.  Wi.ii'll  ii    n-lat.-s."  — AU/II/.;//    l.-ni,--t. 
nia_'ii:!i<-  -i  .t    THUII-  <j,:  aphs    \vhirii    w.-    inav    l....k  "'I'::.-    r:q>i-l    a.l\anci-,   t.v   t:..'    ;;:at.-.l    la':..-^ 

t'n:-    in     >.  :.i:i    .mt.-i'i.-    i.f    <!'nn:i:iy.       All    tlia;  .'f   <  Ira.  •!'.-.    i  I.  ht:i;.i"  t/.   1  t.  .n.i.'i^.   S:i.-!l\v:i  j.   rurl 

iMi.i.-i'n    >.•!    MO'    lia-i    1.  nt    '.<>   Kic1  .iia1^;..  .-i.-.  all  ..'::•  r-,  !.'..•    s-cicn.'i1   l:a-    nri  i-    in  th'-    1  i-'    -::<- 

Tin*    rh.'    in  .<t     c.iri-f  il    n!^.-rvaf  ii.n     i'as    i-mi-  :-  .  n    y«-:u'>,    v.-rv    i:;il  urn  i!  v    !.•>!    i:-    tn    !•  •  k    •••> 

triii'it-ii    to    t!i.-   tr.'.-itni.-nt,    a:;.l    all    ti:at    ill.'  1 1.  rtnaiiy  !'.  T  ti.i- (ir-r  anpi'Liranr-   -.;    ay.-'    rn- 

n;.>-t    p-ri'-nt    r.  •-••:.  r.-h    ins    fMrm-h.M    t"    tii--  alii-   t  j-.-at  :-.•  '.vliich    siii.nl.i   I'liitn-iiy    t.'..1    j.r.  s- 

p-:tii.'..  '/v  .  >t'  'li-i-a-M  s  <it'   t!:r   rvf.  jil'i-  t;:if  lii'l'i-.l  cut  'a  tvanr.  <1    staL'-'    "t     uptit  i,a!nii.-    rn-'-li.'!:;..1 

._:-  :!i'-r"  in    tiii-     c.ini|.:-.-!i.-n-i\i.'    vnl.ini.-."    -  an-l  surt,',  ry.      Pr.'f.  ST.  liwv  h;is  furm-:..- i  ::•» 

!'•,'•'</•>'/  hni  M,II;,-,I!,I>,:!   V, /,•,/;,•,;/  /,'.,•,,,;•'-/•.  \\irii  -m-h  a  ti'.-ati.-.-.       I;   ;<  a  lil.rarv  :;i    i'--lt'. 


u:-:,    'i    -lit!]',-    in  I.,i-.",ir:.t    (,f     this    I k.    a-  />•  'r-.  •>/,'..•:,„•  ,,,'  .!/.,/;.•    .,,    ,,-,,//",.,,-,  .,.„;,. 

tin     ii. us!    L-uinpl.-ti-   an.l  trs-twurt  '..;•  c.  .!,.;•.-!!  "  I'  is  i:.i|.-i-.|    i  irn-at  u.  rk.  aii'i  will  taki-  it.n 

iii:ua  ut'  ..piit  liainii.  I".'1.'  i  nat    has   li.-.-n   uil'rt-.l  j  !a.-i- a^  a  '•tan.lar.l  autiiu:  it  v  in  rv.'rv  ni'-'liral 

t"  An  !-:r!  can  i.livsi.'ians   sini'i-  t!i.-  :i  pi -carat  u-.-,  1  i  I. rar  •,•."-  -/'•!••(!:•    M-  -/c  -c'  .1  -r</'  >•,  /';/••  •'•'  •/••'.;•- 

!:!'[.'.     v--a.-~   a-_'",    i.f   *lu,-    jr-at.     1.11"     iiu\v,    in  ;<•/'. 

i!i,-ni>   i-.-s;,.-i-t.s.  uli-iil. -t,-    \v..i'k-    ..T'    .Mack-tr/a-          "  \Vi- lirtvi-  no  hr.-itatinn  in  sayit:;,' tha?  '  :.H 

aivl    L  .w!---ni-.-."  -  .V.   I.o'i'is  .I/  ./;.•/.',/-,-/>''.•/'.  \v..rk.  a>  :i -.vhulc    is  fa:   t  :.••  !•• -t  whirl,  '.a-  \    • 

npp.  ai-,-  1  n  lv,.:!i-i   :    an.l   M<   a    '  ,.(,k   of   r-  f.  r- 

"  O;     "    •    wiirk.    as    a    whul.-.    it    is  sr;irr.-Iy  i-in-.-  fi.r  t  !:••  <-uiis!i:t-it  imi  of  ar.r!.m-:ty  t!i  u.wC- 

!:.-••  --•.!•.     1..at     wi-    shr,M]4    sji.-ak.        A     tiiir-l  1  •  r  ^  pert  ainii:.'  :  •.  t.li--  oy.  ,  i-  t'r.  .i.ai  ..y  -.\  i' ;...  -':'. 

••  '.n  •  1 1    .     ;.  ! .. ..  >  k  "I  sncii  iiKiui.ii  in  i.-   IIP -an-  in  i'  -  -  ip.  r'.nr    . -\  •  :i  it  ::  h:.s-  r  >  .•.,':  a!  :  n  an  v  .:\:.- 

(  J.-j'nri'-v   \.  .'••.-    niM'-h   v.'ha'    i'     w.nil.1    in. 'an    in  _'irij,'."— .  I  //,./••>.)//     .I<iti  ni'li    "1     '.'c      !/•-,' 

Fn    !a:;.i.     '.'lit     tii.-     ur.l.al    (if    critici-m    h;i.l  >'•-'»   "•.--•. 

Roosa,  D.  B.  St.  John,  M.D..  and  Ely,  Edward  T.,  M.D. 


1  •    n.  :-t   ..[..>-     .n  c\r  P-iii'  !v  n-i-fi.l   uui  k  :   .  "  A-  a  r>-n<'i---  t  r.  :IT  i.-i-  nil  1  '  c 

!-,!    ,  :•    'i'l  -•:-:-.    ••..'"  -.iv'ir!-.    as    it    liurs.  .--..    an  i    i-.:f.    t!..-    '  .M.-i-i, .:-,!:  1  . 

-.•.:.-.     -ii  -•.•!'.;-.•!.'•      '•;•:•.  (-.,n;,i  1,,-  .;,-;!-,•:!.     1 1  1 1,  hi:.-   lK  :t. 

I  -  -a  i  ,',     !..  .     !;.    !    I  •.'!_' I!     c  unt  •'.  II:  in  J  i.!li  '.'  |.t  .  .Illl-r.  "     -     il  ,;'•••-.      /     • 

•  v    -  •  •  . .  '    .  M    t    . •  inn  nip;  :iiit   i  o;n;  -          ' '  \\  .•  :.,-.vi-   /at  <•'. '.   .-i-.-n  -  •   •••  , 

:-..••..-.  .n  i •,.'_;•,      its' ,|-. :.  i.-t.-i,,^   .,.   ...-;, •!..:••--  /•-.:.• 

.•i-.-      til   -   :  Ml     n     •     -i.  VI, i   i     nf    .'1,-ar  /' 


Knnpp,  H.,  M.D., 


1'IT.LICATIONS  OF   WILLIAM   WOOD  £   COMPANY. 

I  >',.•«  </,svx    of'   (hi      J'.t/c    ((//</    hid'. 


De  Wecker,  L.,  M.D  , 

IM  i  l.\|;  Til  FK  VFF.FTirs.  Translated  and  Edited  1>y  LITTON  FORUF.S.,  3T.  A., 
M  D.  F  K.  <;.S..  I.  a!.-  Clinical  Assistant  Royal  London  Ophthalmic  Hospital. 
t  Mi.  volume,  svo.  o.YJ  pajes.  illustrated,  muslin.  Price,  £-1.00. 

••\\T     \i,     Week<  r    has    writieH     a,    \<!>     in-  nude  ml  iti-il    srenius    lit'    the    niitlmr,    his    ^reat 

,    ,  ,  ,vm'  vobnm-.   :ui  i    Dr.     Lltt»n    Forbes    has  op.-ra.tive    skill,    his    vast    experience,  anil    the 

,[.,.,    ,.,„,.  |    s-  rvii-e   in    i<  n-nnm_    it  into  excel-  many  advuneiM  in  the   treatment  of  eye  allee- 

;   u;   |  ;,,    |j,;,        \t   \v  hati-ver  ]>:v^'i-  it    i^  n|n-ne'l  timis  which  have  tiiuli)utiteilly  liad  thoir  source 

(    ,.  .,  t  |.  ]    uj;;  t  !,  !    Miiiir-thin^  t«.  intm-.-t  liim  in  the  iiri^inality  aini    inveiitivt-   power  of  |)r. 

-  •  n.'  t  i.:ii_'  !.•  '\  •  i.  o:  -.-.inn    IM  \v  aj'pliiMt  ion  nf  I)i>  Wci-kiT.      (  'dining  1'ioni   sneli   a   pen,  eaie- 
,  M  ku.m'..  .1.;.         Int                   t!  y  and  airrecalile  fully    revi>e<l    ami    cnmlriise'l,    tlie.-.c    lectures 

•  ,;,.-!;...   ;.     •  •  •    uiiL'lv  of  tliiis.-  will  lie  read  with  avidity  l>v  all  workers  in  this 

,,;  '('>-,  u--.  an."       /"•'••    /   .'        '  branch  rrf  siir^,'  TV,  and  heiieeit  is  not  a  inattiT 

•  \\  ,     ,;,,    i,,  t    ,  \:i_'_:.rai,  >(!;••  importance  of  for  surprise  t  hal   already  they  have  ItiH'il  trans- 

•   i  :i,ii   it   marks  an  era  lated  into  Italian  and  Spanish.,  and   are  about 

.'.    ^ri,  m-e.      The    rapid  ad-  to    be    issued  in    (  IiTinany."  --  l)u>>li  '  n  Journal 

'    •  ,•-]  ecially   on    the  ••/  .M«r«;il  »/•  in;*. 

i  •          •  :    .-•    |e-.\   ye:ir-..  renders          "  1  1  ere  we  have  tl:e  fruits  of  an  except  ionally 

•  ,  •,.    i.;'    th.s    transla'ioii     of     Dr.  larire  evperienee.  and  the  matured  judgment  of 

]',;'••-•  .         •     •     rtuiie;   ami  this   i-.   one  one  wdio  has  contribtitt-d  largely  to   the   recent 

,  •   •        •        ,  ;    •       •  •         r  i'.i:s  of  t  his  work,  that  advances  -,\\:\<  le  in  t  hi  <  branch  of  medicine."  - 

.  te:--.M"-s   and    pi  r-p;cuity  Cl-tstjnii'  M<  <Hi-nl  Journal  . 
:    r  i'  i  i-v  n''  comprehension  to   \\\<-         "  \Ve  do  not  know  t  hat  we  ever  read  a  work 


:'  •  •  •  ;  -:  -;al  v.  01  ki  r.  dealing  a^  jiroiit.  It  i>  a  splendid  r-xnitu'  of  modern  o  pi  i- 

i'  ;  -  •  •  ..''t  .  ,|iie.vtio:i<  of  practical  t  halmolot;ieai  science.  It-  sheds  still  greater 

.••  :  ,-i  aji'ati-il  t!ie  miiids  of  (iph-  lustre  on  the  name  of  it  s  illust  rions  author, 

-•  r_t  o::-  for  -o:ue  time  past  :  and  this  while  it  retli'cts  the  Create.-,  t.  ci'cdii  on  the  able 

i  wh.-n  w.-  r.-membu'-  the  irav.siator."  —  I>ul,liiL  Jfnli'-ul  Journal. 

Buck,  Albert  H,  M.D., 


i)i.M,\n>is  \M»  TI:K\TMI:\T  OF  DISKASKS  OF  THI-:  KAII.     s,,id  only 

[)  See         aje    .")('(. 


Allen,  Peter.  M.D., 


dition  whicli    eventually    i-«-nders    them    jnsn-- 
e  •  p!  i '  '!e  "('  aim  1 1 1  •[  at  ion  .  even    b\    the   ni"~t  in- 
1  •  '  '•  :     l          i  nt  iv  directc  1 1  efforts.     It  is  a  work,  tin  n, 

•      '         •     '  :d'i  ir:.i  '1\    a.  i  apt  i  i|  to  tin    r-  i  |nin-meiit  s  of  :\i  11- 

;         •  •   •      pi  act  i  'e.     and     on-    wiiich     w-    e>pi-i-i:illy 
ommi         i     To    t  ill-     st  lldel't     in     otoli>;_'y   and    to 

ti.e  b  i-;,   pra.'titioiier."       Tl«    W<<li,;tl  /,V. -../-,/. 
"   \  •  '  a  1  '  '  <  t  -i  i  r'i  in  all  it  -  various  1 1  irin^.  and 
I  '  •  •  •  n.|  li'-nt  ions  wit  h  t  he  t  nroat,  is  t  r.  ated 

i   '     i'. i, ei    at    one,     iiitffe-t  111^  ami   satis- 

'      (••.,!•.,          |t       ;s     Ijll  it  e     Up     to    !  i),      im  pl'ovi   llU'llt  * 

'    '       'i  oft:. i    \<i-i-^nid-A$."  —  <  iii'-iitinif.i  Lnn<;t. 

Hclmholtz,  H,. 

'''  I  '  H  \\I-M    i  iF   T11F   •  iSS|i   [.!•>   (  IF  Till:    F  \T!  AXD  M  F.U1H?  A\A  TVM- 

'••    ' •     •  •       'i      !•••  Ai;tl  oi-\-  F.  niii.-i.ni,  bv  Ai.in.K"! 

'•    V"KM  \  Mr  >M  I  •  H,       i      N'eU     Volk.        Oln     Vol  ii  Ine.    oetu  vo,' (j!)   ji:i-c?. 


PUBLICATIONS  (  >!•'   WILLIAM    Wool)   A    CO.Ml'ANY 


Roosa,  D.  B.  St.  John,  M.D., 


A     PRACTICAL    TRl'ATISK    oN    Till:     IHSKASKS  <  >F  Til  11    KAIl.    I\<U  !>I\<; 

Till:    ANATOMY    OF    Till:   olJiiAN.       Sixth    K,liti..n       On,-  YO!U;,I.-.  -  ',]•> 

pa_'os.        Illustrate. I    l.y     lln    w l-.-ii_'r:xviius    and   .-hi-.. tin.  li'ln ._  raph-.  I'r :   .-, 

muslin.  $.">.  .">() ;    leather,  Si>..Vi. 

••  li    any  .in.'  hasthe  ri^ht  <o  speak   !i';ti:i«ri-  treatment  of  ear-t  1-1  iiil.le,   involve-,   a   ••   r  -,  .::. 

ta'ivei\     ii|Kiii    otoloeacal    matter-,     it.     is     |)r.  mate  knowledge  ot    ^'eiieral  medicine  ;    second, 

lloo-a.    t".  .r    it    i>   In-   \vl:...  in.. re    than   any   on.-  ti::it    ti.e  im-aMi:  e  nt    success  i.-,   det'-rmin.  d  I.. 

*•!-•-.  !ia-   made  known   t.i  tiic  American  men  th"  thoroughness  which  the  practitioner  IIMU.'S 

c  tl  in  nt'r-.si..ii   tii.'  tji-li'-ral  priuiripk-s  of  tr.'at-  t>  i  th.-  cxaininat  imi  "I    his  case-.   In-fur.'  ai'i-!-. 

lii'-nt    ..I'   aural    ill^.-asi'-~  ;    anil  it   is    sal.-   !•>    >av  111^'  his  Minj>!.-  a:  maim-nt  ai'l  i;i:i. 
tiial     n.i    h.mk     upcii     any    -i'i-c:al    snl.j.-rt    lias          "It    is    ."i:-ffiili\    incnli'at-'ii    that    not  l.ii.  J  is 

li.-cii   ni.ir.'  wi.lflv  .list  nliu  tfil    thfoiii^hnut    t    .:  to  !)'•   dun.-  \\itii.mt  a  kiujwli'ili;''  i.f  what  i-  r.'- 

i'..iintry   than    has   his   a'lniiralil"    tr.'ati-i'.      Ii  ipiin-il.  ami  tiiat  pnictici:  '  in  t!if  ilai  k  '  •  t.  nt'i- 

this  wi.rk   In-  I'ar.-t'iilly  stmli.-.l,   it  will    In-    seen  t   ve  pnietiee]   i>  1.--S  jn  st  iliahle    in    t:i)s    l.rane:i 

tiiat  t  w.i  main  i.(.-:is  nin  thron^li  th'-  wii..!.-  uf  i.f  ini-i  lieine  than  in  any  other." —  /'/••    .!/•  •/"  .;' 
what    has    l.-.-n    \\ritteii;     tiist.  that   a   .-kiiful  '  !!••< •<!>•'/. 

Bosworth  Franke  Huntington,  M.D., 


A   .MAM'AL  OF  DISK  \S1-.S  o|'  Till',  TIIP.oAT  AXI>  XOSI-:.      Oin-  vulunie,  netav.>, 

-IIs    pa.'eS.        Illll.-trate.l    \vi;li    Wnuil-ellirnivillL'.-.        -Mtlslin.        I'l'ie.'.    So  ','."). 

"  TIL- authur  has  ddiii-  his  work  well,  anil  in         "A    work    on    this    s:il.'(r(-t,    inteii'li-d    in, .re 

eh-  i!  and  i-xpi'i-ssiv  :;i::^:ia^e  L,'i\es   t  i...-    ri  suit  e.-perially  for  the  i;i-neral  piaefit  ion.  r  Tl'.an  t  he 

of  i, is  liy  no  ni.'ans  small  experience.  .   ..     'I';..-  spi-c'ali-t.    is    wh.ar    is    waiite.i.    and    !>:.    !!.•-- 

woi  k.  like  most  emanating  from  the  otin-r  ,-ide  wor'.i    has   li.  (.'n    fortiinat.-    in    tin-    manner    i:; 

<if  tiie   Atiatiti,'.  i-  w.-ll  '.:ntr!-n  MI..  p'Uier.  typ'1.  wiiic:;     he    has    approached    the   snleec'          II:- 

and    \\onilciits    li.'in.;    ixeeli.'iit." — J-Miti'mi'if/i  handling   of   it.  moreover,  has  1,,-,-n    },,,i\\   a'.ie 

.!/.  ./.-.</  ./.,///•//,//.  and  j'ldicions     a  starenient  whicii  an  exam; na- 

••  T.'ie  Look  is  an  excellent  <i>"ciip.oti  of  I,.  -  ik  tii  i- 1  of  tii,-  hook  is   >;:th''-i'  nt  to  substantial.-." 
making,  and    I  )r.  Ho-worth    has   honored    him-         .I//-A/V""    \T '/',,  .,i  \,  ,i^. 

s   If    and    tii"   pro!'essj,in    l.v  writing  ii."       /'/'•  "Tin-!-.-   ,-ir--    a    thousand   ex. •.•'!.-"-'    hin's    ;: 

.  I  ,...,-;.•,/.,   /',•.,.•' ,/.,,!,.,•  ji,js    v..li:m.-.  \\hi.-h    is  an   emi!i.-!t!\   praenca 

"  Tin-  a1  it  :.!>:•  ^ri  \ .  •-  Us  a  1 k    a.-    in-t  met  iv.-  inaimal,  e.  inalh   ered  ira  Lie  t-i  ant  hor  and  pn'i 

a^  it  i-  int. -i-e-tnu.   not  aione  to  the   specialist,  li-lier,  well    iih  si  ;  at- d.    ait..ur.  tin  r   a    work    t.. 

li'.t    TO   tin    e.-nera!  practitioner   as  w>  il."      >'.  I.  •  recommended    to    li..th    stndei.t  and  p!a.-ti 

/....,•-.  <-li,>;-"-'  /.'•• "/•-/.  tioner."  -II.-    'a „,„/,,  /.„„,;  t, 

Van  Troeltsche,  A. 

DISHASKS  OF  TIIK    i:\il    IN    I'll  I  l.DUF.N.      I'rice.  sl.T.O. 

Saltcr,  Henry  Hyde,  M.D., 

I'.  ".  .-.v    .f  '':•-  li..-,  ;M  i  '..  '    L.'.'  ..f   I"  v-;     :-,'-:    I ';,\-i.  •;;.',    t,.   I  '!,  ,.-;.;•  . '.-.     -   i  I . .-; , ; :  a ' .  n ! :  1    I..  •   •  .-   -      •     •'•  •• 
I 'i  i'.eii.;.  -  :,ii.l   l'i-a."j.'.-  ..T  M.-'i!     :,.  .  :c   i-..-  Cli.»r::!_-  (  'n  —  !  |. .-      i.i.   M.-  :  .•.,:  >.-'...,    . 

ON    \STIIM\:      ITS  I'  \Tllol. ill, V   AND  TK  KAT.M  F.\T       S..M,.; 
Se,    ,,,_,-  r,4. 

See,  Germain, 

V,-  •:.••••  r   ..f    the    Pa. ••;:!•,  ..f    M.    i  ,  a.--  :     M.  :-,'.. -r   of    rh--     \e:i  ••-.;.      f    V.   i:, •'•.,•  :    ;";• 
1 1:.    :.     r-  .   I 'iiris. 

IMSKXSKS  ni'  -I'M!-:  i.i'Ni;s.  ( •!••  \  si'i-:<  IFI<\  \<  >N-Triu:i:cri.( "  s  \  \TJ  i;i:. 

\eu!e  I'.nmeliin-,  hif..,-tio'i-  l'!,e,m,,,Mia.  ( ;,'iti-ren...  S\-|.!ii:>.  Can.-.-!',  and  Hv- 
ila'i.U  ,.f  tlie  l.uilu-s.  Trali-lati'd  l.\  I'..  I'.  Hll.'l-.  M  .  1  >  .  \! .  in  h.-r  • .  '  h  •  .M  ..-'a- 
chu-etts  V.-lieal  Sociery.  \'ice- 1 'r/.-id.  n:  (.f  :!,.•  F—  x  \-:';:  I«i-;:l."  M.-.i:.-:il 
So.-i,'t\  ;  One  ..f  the  rhvsifians  to  :!:•-  \:iiia  .I.eiie-  !I..-p::.ii.  N'.-u  !.in ;,  p..r: , 
.Ma-~  WithaiiAppendix  li\  tin-  Tra:is!at..r  on  t':..-  (I.  i-iiiall  Theorv  ot'  |):-.-a.-e, 
and  on  the  Tul.ercle  Kaei !',  u-  S,.:d  Ls  -  ;  I -crip:  i.  .11  ..:i'.  .  .  >.--  pa_.-  "il. 
^  -  •  '  I  >ne  of  the  n.o^t  \  a lua  1.1.-  \\'..rk~  on  t  h-  sulrect  <.f  '',  cent  t  ime-.  tui!',  up  to  late. 


I'l  IJLICAT10NS   OF   \\II.1.1AM   AYOOI)   A    COMPANY. 

/','.x,  ,/x,  .s-  i,  T'  tin    .\ii*<ij   <  'i/riftfM,    Lti  nj  n.  i'.  if*  . 

Scmelcdcr.  Dr.  Fricdrich, 

n.i-;      ,  J.i-Mn-.    '    .  •        ••.:.-••     f  Mevicn  :    Member  nf  i  he  Royal  Miilir.nl  Society  ..f 
•,      •   l'a-ithe.,n  in  I'iirU:    I',  nm-riy  Member  of  the  Meilical  Knci'ilty 

,      I   •:  -..•.-::.      :   ',.,•:  •   •  lln'  llnineh  ll-<-i.U:i!   ill  i  I  <-,m]n-nii<  ,rf. 

i;iIINi>»  t'I'Y    \M>  I.AKYMiOSt  dl'V;    Til  HI  K  VA  1.  1'  K    IN    i'RAl  Tl(  'AL  MKDI- 

(  ]N|;        rra!i-':itcd  Cennaii    1'v   Ki>w\i;n    T.    (    \>\\  I.I.I.,  M   I).      AVith 

hie   jo.-ites.      (iii''  viilmiif.  uctavii,   l!lj   pa^es, 

•.       .    '       nl    lids     i',l    tilr   I't-»lVs-i..li;il   JMllillr   tn  \vliulu  it    i-dlnt-s," 

::i,-tu-:il        -  .\rir    }'.,/•/,•   M,,li,;il  JultriKll. 
\.li\.  .    .1':   I'.'.'       i"  '.!•  \r    1  '       .  till'   M   rilii't 

Mackenzie,  Morell,  M.D.,  London. 

iu<r.  \->is  UK  i  HI:  riiAitYNX.  I.MJYNX.  \NI>  'I'I;ACIII:\.     niustr:it«-ii  i>y  112 

Sulil    ulllv    liv    Mll'-iTil'tii'M.         SIM.    |.;i-i-  .")(!. 

Robinson,  Boverley,  A.M.,  M.D.  (Paris), 

••     ;i     -In-  TJi'lIcviii.  H.i'pitnl  Mi..ri-nt  Ciillr^c,  Xi-\v  York:    I  Ir.  •-  -.-i.in  i,,  S;  . 


James,  Prosscr,  M.D. 

YNi,ii<f(tpY    \ND    I'.IIINOSCOI'Y    IN    DIA<:\OSIS  AND  THKA'r.MHXT  OF 

'>'-r\-l.-  OF  Till:  THIHiAT   AND   N'OSK,       [••..unl,    editimi.   enhu-L-.-d,   uin- 
-       .  i  '.rated     M  i|  !      -  i.  lid-ei.     •     .  :  •      -.   and   !i\  ••    liaiid-cnl  - 

.Licobi.  A..  M.D.. 


Ross.  James.  M.D., 


iri'i-e    clinical    digest.       It    i-.  an  en  - 
nd    i.f   r.  fcri  nces  in  the 

M-  nl'    [-'ranee,   I  '.  ,  n,;an\       Knuland.    and 
T  ,M  i  k     may     I"-    c',n.-id.  ml    a 

!   •  ij,    nii,-t  a  lit  i  ent  je  literal  me  nf  t  Ids 

)-.„  .;-   ][.,;;.-.,!  .!,.„,•„">. 

It  :       v  l,i     dli     i  d  t  i.at   1  in-  xt  iident   <'f   nei- 

I      ,w|,ere     el-e     tilld      all     t  llC 

:     -        'it,  /•  l  her  in  a  fiii-ni  -<i  convenient 
.      .  \1      ,,,,'  \,  ,r.i. 


PU3L1CAT10.NS  OF   WILLIAM   Wool)  A   COMPANY. 
I)ii$t(tx€>$  <>f    tin*   A  >• /'/'6>//.s'   .S'//x//  a,. 


Rosenthal,  M.,  M.D., 

A    CLINICAL    TUKATISK    ON    'I' UK    DISKASF.S   <>r   TIIK    NKRVoI's  >Y>TK.M. 

\Vitli  a  Preface  liv  I'K<  )K1  :--•  t|;  I'll  \K<  (iT.  'I'l  •alislated  from  the  Author's  Revised 
an. I  Lnlaived  K-litiiiii  l.y  L.  I'lT/.li,  .M.l>.  \i-itin_  I'liv.-i.-iaii  for  N.-IV..I;-. 
1)1.-. -ases,  Randall's  Island  Hospital:  l'liv>ic-iaii  t..  tli.-  <  ia->  1  -r  N.  r\ 'oil-  I  '!- 
eases,  I!-  •!!'  -viit-  Hospital  <  >iit-d.M.r  |  ),-|,ai  t  HP  lit,  and  I'al  li>.l,,_  i-t  t-  the  Lunatic 
A.s\ium,  iJlackwell's  Island.  Illustrated.  <>MO  \  "1  nine.  s\  »,  .YV>  j..i_  .•-.  mii-l  in. 
['rice,  $.")..")(!. 

"  Km-   a   treatise  on   diseases  of  the  tiervoiM          "  T!.i-  ^reat  ad\;inces   thai    have    !..,M    made 

s\ stern,   tin-ii-    is   no    work    ttelter  arranged   m1  in  the   d.a_;nosis,  pat  Iniln^s,  a  nil  triatnunt  of 

Iiioi,-    scient  ilicall  V    executed.       The    author    U  nervous  disi-ases  ot'  late  \  ears,  have  l.i'en   ii..t..| 

iilent  itiecl  \\ith  thi:  nio:e   a'lv.-n  ri-.l  ilisi-i>\  ei  ie,  in    this   tn-ati.-e.  ami    we   rlieer!  ully   i-on.ineinl 

aii.l    re-earrlies    in    this   ino>t   ilitlicult   tieMoi'  tin- Imok  to  tl.i- ]irnt'i-ssinii. "—>'., K///I  ;•//'  /..M'.-. 
liieilie.il  srienre.  aii'l  we  ina\    salely  as.-ei  t   that  "The    \\ork    i-    one    wiiirii    iieui'o'o^i-t ,  will 

110  other  linuk  will  LI\I'  inofc  Kciietit  or   int'or-  scan    with    interest. "--  .!/"•  '/•'-  "I   >in'l    >'///•./.'.•,/ 

ih.iTinn  on  ner\  cms    .  ii-ea-es.  "  — .  1  ffitiit'i    M'  '/i-  /,'• /"</•.'•/•. 
,;,'  .,„,/  X./ ,-,//-•.//  J<»t,-,,,ll.  •'•  Thiswoikof  Il4»e!  thal's  hasl.eeii  a>tai:,l 

"  Ainoni;  tin-  merits  of   this  hook  worthy  of  ard  on   tin-  diseases  of  tl.e   nervon^   system  in 

>j.e,'ial  ment  ion  a  if  its  imit'ormity  of  plan  and  (  i>  r:i;an\   and    A  u-tria  i'oi'  a  mm:!  c-r  of   \  ea:  -. 

systematic1    divisions     and    siilnii\  i^ioiis  ;     t!;e  having  i:one  through    -e\  eral  edit  i-  .n-.      It   i;as 

\\ell   c'!m-f!i    anioimt    of    -pan'    and    attention  I.e.  11  tl'aiialated  into  Kre.'.eii.  and  reei-ived  t  :  .-• 

\\hieii  a:«'  ili-viiti'cl  to  each  di-ea-e.  l!ie  rarej'n.l  comnif  ndat  ions  ot'  Fivni'h  Neiiro-pat  iioln^i-ts, 

]in-eiit  it  ion  of  t  ne  -.iiliject,  of  syinptomaiol.  i^'y.  esptjcially  I'r.  it'e--.or  ('harcoi,  who    is   tie  aii- 

ilia^iio»i~.    and    prognosis,    .-i;id    riie  iriiiii-roiis  thor  of  a  pjvfacv  to  th>'  American  tran-!ation. 

c'oin'isc  reports  ol' original  )iatholou'icjaland  his-  The  work    is,  as    it    purports    to    tie.  a   ehuieal 

tolcu'ii-al   !.li~ervatioiis."     -  /',', :!,,,!,  :/,.',;,,   .\[,<l',-  one,  l.eiiu  i-1'erially  full    in   th-   prac-t  :.-al  .!.• 

i'ii'   Ti'inX,  part:nentsol    symptomatology  aiid  tn-at  ;i.c-nt. 

"The   1 k    lias  many  in--rits.  and  jiiueh  to  The    pat  hoio-ric-al    du-.'i'ip:  !•  .ns   are  al-o    made' 

foinmciid  it   to  the'  attfition  o!   the'  piof.  •-•do  n.  prominent,  and  are  nnu-iially  clear.     T;.<-  oat  i 

ThN  i--  c.spi'cially  tri-f  in    regard   to  the-   ela>-i  fnrni-heil  l,y  clii:n'al   uliservatiolis   and  p.itl.o 

tii -at  i  on,  t  hedf. script  ion  of  many  diM-asos.  and,  logical  anatonu   a  !'c-  e \plaii.ed   as  far  as  [  c  --: 

011   the   whole,    in    regard    to   t  ivat  mcnt . "      .I/'-  Me  l>y  physiology,  Imt    I  )r.   Itosent  h  ,  1    divotfs 

<-hii;.-inj'   M.  .I',,-;, a-.  very  little  space  to  thf  01  ie  s   r, -nrdi:  -  ph\>io- 

"It  is  systematically  arranged,  and  is  writ-  logical    nn-rhanism,    ditl'eriiiLr    in    ti;is    respect 

ten   in   a   st\le   that    is   plain,  clear,  an  I  forci  from    mo-t     rer.-ni     \\iiiirs    on    m-rvons     di- 

l,ie;      is    devoid    of    hypothetical    speculations,  .  a-es. "-'/',.',,;.,     \f- •^•'•il    •'  '<>    .V</ ;'•/.'••< 

and    -tarilin'    and     remarkaMe     cures."  -'I'/,-  //.//. 

If, /,-;   1 1,  „!„'  .1, ,„,-„. il. 


Beard,  George  M.,  A.M.,  M.D., 


"  The  1  took    is  wi  in  en  in  the  author's  usual  or.:  aide  changes  in  t  !.,•  varion-  de pai  'm*  ::ts  of 

Iu>-:  1  -!•>  !e.  and  exhil.its  t  ho  results  ,,f  original  lie    ni-r\oiis    s\  stem.      \\'e   can    n  ..- 1   ur_etitK 

r   -e  . :  c.i   in    a    m.<st    i  ni ,  i  e-t  in.;  d,  part  men  t    of  recommend    to   ail  ph\  sicians,   an-i    to    n,  :  \  ,c;s 

me  ii.'ine        Tt:e    medica!    world     owes    to     Mr.  specialists,  in  part  icnlar,  the  W.M  k  !  er.    Icioilv 

I'.-arl    its  \varni'--t    a  Iniirat  ioti     for    lia-    r.-d:\  icviev.ed    as    t:,e    result    of   aliundi::1    prac-lical 

:;o  ,  1  wi ,i  k  u  hii'h    he    iia  -   done   :u    this  special  experience,  and  o|   sharp  i-rit  ica!  •  .1 .- er\  at  i"!i.  " 
jW.f'-'ii-at  ion.  made    in    tile    ne'itral    -pace    I,,.  .  1  "/r  „,,;„,     II",       ,-    I/    ,','../     >*J      > 

fAeen     eleai      pli\siolouical      and      pathological  "The  I k  is  f>dl  of   ...  i  ;  i,    ,1    r.  -.'- nvh    and 

'    M      11.  ,11  i   .".  is.  more  t  nan  anv  ol  iier  \\  i  iter  |.  .m~.  c-t  iolojv,   and     1  i  e  . '  :>:•  :  t .    a:  e    a!i,p  -.     ;! 

of    the    da  \  .    coi:t  i  ihute  1    to    e-t  1 1,1 ! -I,    t  'a-    t'act  his)  rated   l,\    cases  \vhich    !  M  \  .  •  ci  ci  .-  u  la  ii  -r  !  h  • 

tiiat     /rave    appe  ir.nice    ol1     loc-i!     di-ea-i-    may  author's    ,,\\n    ol,-ervat  i.  ,n."       '    >  -i-i  •     I/-    /' 

c'Xlst    wit  ii  out,   I'l   I  act .    ha  \  in.;    a    lo  -a  !    organic  n  nil  >i/  /•,/,',./•'  -In  '••  r  > , ,- '. 

haliit.ition,  or  reiiuires  a  name  diss,  vered  from          "The    p:.-f:a  \\m  k    treat-    of    the   di-ea-,  d 

tiie    ueii.-ril     nervous     s\stem."       .  I',',  /»,'-'    :in'/  c-oiidit  ion  wliicii     has.  m    the    list    ,  ie.-adi's,  1  e 

A'-"  come   s,,    d's-em.inat  •  d.   not    onl\    in     Atne-ic.i. 

"The'    merit    inc'ont. -tatily    l.elon-s    (..     Mr.  tint  aUowitli  n-.   in  lo-rm.u, 

Heard,   of    havin.;   pro\  ed,  on  a  scient  i  !'c  1  ,as]s,  litionc'i'    c  iic-oiinters    it     on    In-    ro'tii  U.    -e'  e    ii 

the  existfiic"  of    iic  urast  hc'ilia,  and    lia\in-,ie-  times  daiK    "       /•'/',>,/,    ''/•    /'/'-/•/.       .-t   ",•    '.,;•- 

lined  the  difference  !>ct  ween  this  form    of    n.  r  unni    I  r  >n  ~ ',/',.)'. 
v.cisi.ess  and  t  hat   which   is   the  expression   of 


«"i;       ri  jiLicATioNs  <>r  \\ILLIAM  WOOD  A  COMPANY. 

/>/st </*<  X    at'  t]i<      .\ 'XT'*.    Aj>Oj>l<:,rij. 

Gowers.  W.  R.,  M.D., 


-.-.%   f.    •«>-.•  11  ,-i  .M.       1  !,;. 

LPii.F.psY  AND  OTHER  CHRONIC  CONVULSIVE  DISEASES.     Their  cause>. 

>\  Hip!     1;.-     atnl   Tfi  iitllli  lit.        >o:d    l'\"   subscription   Olllv.        Si-e  pULTe  ,"")!. 

DIACNosiS   OF   Till:    D1>EA>ES   oF  THE   J'.RAl.N    AND   SPINAL  CORD.      Sold 


Bramwcll,  B., 

DISEASES   ol--   TIIK   SIMNAL   CORD.       Trie...  s:>.l)0. 


Putzcl,  L.,  M.D.. 


A  TREATISE  o\   COMMON    FOR. MS  OF   Fl'.Xt  TIONAL   NERVOUS   DISEASES. 

Si  M  milv  l>v  sul'MTiption.      See  p:ue  ."">(>. 

Lidcll,  John  A.,  A.M.,  M.D. 

\   THKATISI-;  ON    APOPLEXY    CEREP.RAL  HKMoR  RIIAC  F.   CEREBRAL  TM- 
I'.ol.ISM,  CEREP.RAL  COCT,  CFRKP.RAL  R  II  FC  M  ATIS.M  .  AN  I)  KPIDFM  K  ' 

ri:i:i-:r.i;o-siMN.\L  MI-:NINCFI'IS.    on.,   volume,  svo,  :;!).")  \^^,  mu>iin. 

IT;.-.  St. I'd. 

•    \\",    1 1;  nk  I  i.c  niiiili-st  hnii'  nt"   the  ill.  tin  1 1'.  "  To  ;ill  I'rieinU  ot'  ours  \vlio  are  en^u^c  1  in 

:iv    .\:i.--    .1      n     ti,e    |iret';u'e  to   tins   exiellent  t  he  st  ltd  \'  or  T  n  at  ineiit  of  ei-rcl  irnl  diseases,  we 

iiii,.    t!:at   i'    uill   [ri'Ve    ! :  t  eiv.-t  in_'  iiml  eonliiillv  coniiiieiii  I  t  his  work  as  t  lie  ino.-t  i-oin- 

•    ,'t;:o-r-  -,\li,)  p.. -id  n.   will  )»•  t'ully  n-a!  jilete    aipl    Mit  ist'iu'tory    of    ;iny    that     we    have 

:.  .    :.      .     .     .      We  heartily  recommend  the  work  -ecu.      The  mechanical  execution    ol'   th.'Work 

,il    |  i,-     ]..  ;.  r   T,,  i  '  r  prof. -M..U    as   oi:e  of  very  is  excellent."— /A  ^/-.-iV   /,'>  i-ii-ir. 
/"     '„        ',,','»,    .If,,/;,;,!    Til,,,*.   ' 

Erichsen,  John  Eric,  F.R.S., 

-    •,.          •  >••-.    •      n-ir-,    ),,  th-'   i, i:  :    l-ln.iTitu-    l'!-Mfr-~..r  nf  Clinical    Suivrry   in    I'Tiivcrsity  ('ullc^.., 

.:••••    :     •  r  th.     II   •   n  till  :    V.\   I'lv-i.li-nl    nf   tiic  K<  iviil  ( '.  .;:'CLTI-  .  if   Surirfoii-  of  KIIK- 
i.    M  i,   :,',.''   il  •.!•_:•  :.:    >...•  ct;.,   .  tc, 

i,\   ciiNrr»io.\   OF  Tin:  SIMM:.   NFRVOTS  SHOCK.  AND   OTHER    on- 

-ii    Ri:    l\.M'R!i;s    OK    'I'liK    NFRX'OTS    SYS'I'F.M     IN    THKIlt    CLINICAL 
AND     MF.DIi  o  !.!-;I;AL    ASPECTS.      One    volume,    1','ino,    :M  I    paws,    mu.-lin. 

T    .  :    :•;    his  j.r.'facc    ex-      r.'lilwtiy    coi  1  i.-ii  ills,    they    wfe    not    peculiar    to 

plan      •  '  '...   a-    having  lieeii      t  hem.   lint  nii^'ht  lie  the  I'OliseqnelH'e  of   any  of 

r     in  juri.  ••   ..I    the      the  more  onlinar\   accnleiit  s  of  ci\  il  lite.      As 

'      .  .       '      .     r-  the   Work     is     llo\\    presellteli,    it     illclliih^    ei'Jit 

•     I1       •  : .  •    • . .    '    el,     .  .     ]•,•,••  i  v  ,-,|  in   c.-ili-     a.l.litimial  lectures  anil  has  IK  <-n   expandeil  in 

II       ••  •   .      ;  .  •    |.    Mica-      -cup,      I.,    einlirace    a   wider    raiiLTc  of   Milijects. 

ill'  i  i  :  . '  : .  •  •  ' . '    •  ••  ,  :i      la  ru'e.  ol  iscui'e.  and  ini].oi  taut  elass  ol    in  juries 

-in-       ol     •;,     ui'rvoiis    s\>ti;iu,    thl.s    work     is    highly 


Richct,  Chas.,  A.M.,  M.D.,  Ph.D., 


ITBLK'ATIONS  OF   WILLIAM    W<><>1>  A    COMPANY 


Benedikt,  Moriz, 


AN  ATo.MK'AI,  S'lTDIKS   ri'oN  UliAINS  OF  rltl.MINAI.S       \  •  (  >\  TK  I  111  Th  »V 

TO  AN  niKoi'oi.ocY.  .Mi:i>h  INK.  .11  HISI-KI  IH:N<  i:.   AND   i^vriim.- 

0(IY.  Tra:»iat.-l  fi'.nn  the  Cci-maii  l>v  K  1'.  l-'mvi  I:K.  .M.D.,  N.-\\  Ymk  .  !>.- 
pai'tnu-iit  I'i1  Traii-latHm.  N.-\\  Y<>rk  .Mcilieu-<  'liirnr..'i'-al  S,,,i,  ty.  I  !.  ,,-;i  .,•-  •! 
v.ith  \v  .....  l-i-iu'ravin_'.-.  On,-  \  ,,,  [.Hi--.  Svn,  !*••">  pa.'--,  luii-lin.  I'riec,  s!  "in 

••  ]t    i-   s'rietly   M'ieutilie  p!;i!;mt':iri>pv.  an.'i  l.iek   <•{  tin-  f-,-ntm,-  -nt    "f\s:i.i;_.   t'-,.,':Ji  •,•.  j-'n 

r.  :,,-:..  •-    in     tli--     M'upe     <i:     trie    linma:ii/in  _•.  a    i!i-ir    pcreept.nn    nf   i'.    .  .  .:>••!  r  ;!••    !    .•    -.•.., 

(  'iinn'r'-hi-M'iniu'   as    it    dni-s   t  hr  ;  i--\  c'1..  \\«::  \   i.f  privi-iiial     ps\  t'!inl,r_'i|la]     c::ai  :iri  .-:  i-,»  ],•-,       •     -\ 

«i:ir    i-xi-rnn-i-.    it    la\  s  hc.l.i    n;i    iart>  inn^t   |-  r-  r!a~-  !••  wliii-li  1..-1..H-.-.  f.^r-     tiiaii    I.IH-   .'.,,1      i>f 

tilH-nt    In    t  l.i'  \\    It'al't'    cif    Mu-ii-ty,    ili'llviil'Kuiv  <•"!;.  |i-inlif  I  r:  iniinal-. 

aii'i    i-ull.-i-f  i\  i-lv        111   1'ai-l.   it    Aprils    up  :i  very  '  II     ?h"-.v^   <!•  lirii'iii'ir-i  in   til--  1-1-!  I-!HM!  ,•"•: 

liin.iil  aii'l  ciitiri-ly  lii'u'l.-i-ti'il  MIMT.'I-  nf   int'nut.-  ^-t  it'H  inii    »f   rMinin.N.    \i/    :     ii.  !:rii-::t     L_ 

.-!   i  i\.   aii-1    >hiiilM    ;i\v.ik'-l!     liru    j'.--t-aiT!i    ilit'i  c  if.  '•'.<>;  .1111-1,1  .  au-l    a    rnll-r-pir'it   •  -.1  •<•-•.    i-!    I.- 

Iin-:it  ii  p:ii-iiuiiu'iia.  ^-.r-~,   wnl'\i  :ir-    f'.tr  laiir-lil  a;  .'li-!'i-  -t  -.       T!.,--- 

'    Ih      l'i.-    i-  likt  i-  nl'  iijiiiiinii    t'ri.-.t  an  ilia',  i!-  ilr!'i-.-ts     ar.-    <-\iirl:t      t  lirniu'iini.l      !:;••     f.t    :i- 

i:\    tn  i,  '.-.train    t  :K-:QM-!\  .--   I'i  mn  t;n-  n-pct  it  i-in  extent    "!'    I'M-    l>rain.      Ti,'-    \v,.ik    i--    .:     i::-at, 

nf  a  i-',  iir.i-.   iintwith-laiiiliiii;  t  !)<•  full  appiv  -ia-  value."  —  1  1  •  -'•  i'n   JT  -<V'  -/.'  /,'•/."/•''  /', 
ti'iii    11'  th"    ^  ipiTi»r    jiuwer  ul'   th-;   law.  airia 

Charcot,  J.  M., 

!•:-.'.    -.  r  ;:i  I'..-  ri.-.-.'.ty  ..f  Me.li.-in.'  nf  Tar.-:   Cir-  f.  f  t:..-  S:i'!..':-:--!--  It-.-.1';  '"  :    V'-::-!     ••      :"   •         '     i- 
,--.;:--  -:-•  \!'-  ..-I-  i..-.  .if  i!i--  i  •.:i.ii-.i:  >  .....  -y  •  •'  !.-'••  i  -n  :    Pn--  .!.-;.:  -.:"  1  !:.-  S.  ,.-:•••.•  A-  .»••:.    ,-.--:    ;'   - 
•  .    :    \  :.-.-  I'M--:  i-  1,1  ,.f  in.-  S.n-  >><•    !••  !;:•  i.-'^-i",  •:•..,<  !«'.. 

i.ij  TI  i:i:>  o\  i.ocAi.i/ATiuN  IN  I>ISKASI:S  or  Tin;  nuAi.N.     i>-  '    :.-.i  at 

!  !..•    I-':  i.  MI.;.'    .1.-    M.  i  Ice  in.-.    1'uri-.    I  "•>">.        I'Mitcil    liv    Ki  1  1    i:\l\llli..       'I'i  :i!,.-!  a'  --I 

l.y    Kiiu  \i:ii    I'.    IMIWI.I.K.    .M.D..   \i-\vYm-k.       L  m~:  i-at.-.l    v.iih    :'..rt\  -:!  v.-    :iiu- 

\v  .....  1  .-]u'ra\'iii_s.      On.-  viiiuiii'-.  ^YI>.   ]:!:!  pa_>-~.  inn.-  i;i.      I'riee.  sl.."in. 

•      \Ve    i.eavflv    .-,!!,  HI,  etui    t'le    1  .....  k    1.1    Jill     -f-       I!    Vlnil'   '    I  •   til    -    I    -  T  'Ml!        I-     ,    Xa-'l't"    ie    il,    rcll- 

(i...  '---',:-  r\e  -I  :-'  ifi  ie:--.      I  r  t'".'.-.-  i'-'-t  •;;  e-  t  :..-  o  ii  :n:i  •  -I"  1     •     '  •:    _-i  !ia!  !:.•  ;      i:  ^.  :i'n  i  a  -   a    <-!ear 

7!:.-il  i  .-I1   i~   f  iM-iii.-ic  I  in   t  '..r   i  lire  -t  'ii      pnint  e  i  an  i  I.M-  \.-.-i.;  .1  >•  •,!  -i  \  !e  .'!.:..  '.  I 

<i;t  '  iv   IP  Tin.'i!  ii'iii*  iitn\   a  II-  1  eN  i  i  t  iM'i'Mt  a  !  i  'i:\  •-  ••'.-/   ./«•   /-..''..•'/',.     I/.    /.'  (/-'  >,,...-,. 
iul'iL".'         Ii  ",t    a-    >'it.pl'  in  i-!i  t  a  i".    1  1  1  t  n  ;~,   I  !;.  iv          "  A  :.  -.  •  h':i  :  l"r<  '•  i  1  1n-  t  e  i  '  r  '  i;  --  •  i:   .M    <  'l.rir 

1-    .-.-Me  i    elitii   "il    ;i!l'l    pati.il!i'_'!i',al    M--I-  ireh."  eot       i-      I!!       i>!iee      tl'-a-irel     li\      lie     pliill      -I'll. 

"l--n.M    i'-    i  \f.  •'!•!"     sty1.-',  rui-i   \\  it';    ;li':--  *:i  M  n!'  ee'.e'ifa!  In.-iili^itim:.  Imth  a!n    ea'.lin 

t:a'..),-    -.1    _  .....  1    fia      he    may  i"  il  t  ;.at    u-i.is  e,  ,i  ia  Imrai  ii  n  \vlt  '.:    .M  .    I',  tie-    an.  I    '  t   ,<"  ~.   •  hat, 

t:..      'e--n:i^    \'.:.ii'!i    ill.-,     t--aen.       |)r.    l-'n\v]..|''s  he    i-    ;'.i     a     po.-ilinll    tu    ,-Jie.ik  .  .     .. 

i:,,'.  -:..•.  ,.n  i-  en-  IT-  .1   !-;.   C;iai,'    t    hiin-.-li'   a,  .)/.•/     •>     /,'.-../'./. 


Kamilton,  Allan  McLane,  M.D., 


S?c'uiii,  Edward  M.D. 


I'UJUCATIONS  OK   \\lU.i\M    WOOD  A   COMPANY. 


Burtholow.  R.,  A.M.,  M.D. 


Harrison,  Reginald,  F.R.C.S., 


i.iicTi'iir.s  <i\  TIII:  si  KCH  AI.    i>isoi;m:i;s  or  TIIK  IKINAKY  OKCANS. 

1  i,       ,  ,  •      ;       •     :     •      Liver] !     linval     I  ntirniary.        One    vnluuio.    Svo.     oil!)    paues, 

;;_,-••  •         tl       .    ;  :      and  \unxl-riiuruv  iiiiTs,  muslin.      I'rice.  S-l. ','."). 

••'!'):>    ,.\:;\  :     M:.     I  I  c.  i  :  -.  !.'-    leetures  orders   of   tin-    Madder   are   c|iiite  fully  treated 

!.--.  i,  i  •        •  '1'lie    w..rk  ut  iu  tht- latti  r  liulf  ut' the  houk,  and  Lr.  lii<;c- 

;:rit-il     •'      '      .••;•.       \arioMsini-tlnidsuf  low's    uperal  inn,    lii  liolapaxy,    i'avoralily    coni- 

•:-.••!_!'.!    e.i.'ii  .  \i-'  pi  imi  in  1  >r.  inented  mi.      Injuries  and    Mir^ery  of   tln-kid- 

ii-   -    !-.i-rli."l  i.!'.  i    mine,  injuries  iievs    ari-    eon^iileieii  in    Cliajiters    '-'">   and    '.'(i. 

li.ra,  i'i  i  in.  .!   ' >;  il;e.  etc.      The  dis-  'J'iic  \\cik  uoiifludcs  with  a  lull  index." 


Coulson.  W.  J..  F.R.C.S. 

ON    riir.    DISKASKS  ((!••  Tin-;    r.i.Ai)i)i;i;   AND   TIJOSTATK  CLAND.    sixth 

:        (Mil-    vnlmiie.  Svn.  li'.il!    juiL-'i's,    liaiidsniiiel  \-    i  1 1  u.-t  rat « •<  1.      Sold 

:  '        .       : .  >•  >•    |  >a    ••  .).). 

Ncubauer,  C.,  M.D., 

'  •  •  ,  ':xl   l.al»n;Hui     .ami     |i  ic-ciu    in  tin-  Clu-inieul  l.:iti..r,it"rv  In 


Vogcl,  J..  M.D., 

Of    M:,     ,-. 

v  i,i  IDK  ri'i '  Tin;  i,»r  M.ITATIVI;  AND  <?\'  \\TITATIVK  ANALYSIS  or  TJIK 

1    i:i\i:         I ».    :    •      i     for     !'i;      ,-j    !IS.     Ch.-nii>ts.    and      IMiarniacists.       ^'ith    a 

I        ',.    •     •  •     !'•••'      -  'I1   l>r    I!     l'i;i  -l-.MI  s.      Tralishiti-d  tr^in   the  seventh    enlar'_''d 
l',diti"n    l,\     r.i.r.i:  1 1  ii .  i :   (i.    ('1111:1:.    >].!>..    l'!i\>ieian    to 

1  M.-o-.-i-  •  Its    d  Hi  •         !I<  -pital.    I'atlioliij.rist    at    the   r.o-toii 

'     •  \.--i-t:iiit     in    1'athoio.  y   in    ili,.    .Aledieal  Srlioul    of    Harvard 

I.',  l.i>\\  \i;n   S.   \\,iui..   .M.I)..   I'l-nlV-iMir   of  Cheniistry  in 

Harvai-'l   I    niver~:tv.       In    ,  in,-    siip,-rli    Svn    vnluni.-,   "i."i  I 

!i    1  \\  it  h  eiuravi  M-S  and  lour  line   elirniini-liilinura|di  ic 

!    .'     .      !'  .  si;  <,M  :    .,  ..-  i,.  ; .  s;.ini. 

••      •          n    ;    'tual      Irs-ly    the    innsf    emnplete   and    comprehensive 

•  •  t  '.•:••  i  !  •  '•     ••'.  i  rk  ol   it.-  Kind  in  anv  l.inun.-ije.      The  nil,  m- 

•     •!•]••'  '     •    i  •  o  t ,i  ,.  i,        ei.pie  ill iiM  rat  ions  an-  unsurpassed    in  p.  n'.-i1- 

I        ::  •    'han  leal    e.xeeut  ion    t  li>-  Ixiol,   i~  a 
.:    .I"-1'  •    ,   '  :  r          .peeJTii,  n    of   ait.       \\V    s.-ldmn    w  e  a. 

•  .1,11-.  "---/',/,;//.     M. ,/,,;,/  ,,„,/>/,•- 
I      •.-...:.•.•.-  . 

'  . 


Bclficld,  W.  T.,  M.D., 


Milton,  J.  L.,  M.D..  M.R.C.S. 


PUBLICATIONS  OF  WILLIAM    \V()()I>  ,\   COMPANY.          .">'.' 
l)isrttt<(x  oft/it    I\  hint  //x  <fn<I   (  riniini  (//•'/<///*. 
Gouloy,  John  W.  S.  M.D., 


1MSKASKS    01"    Till!    IUINARY    oRCANS;    !  \<  'I. I"  I  )I  N( ;  STK  H  "IT  III!  <  >T  Tl  1 1! 

ritr.THKA,   AI'!T.<  TK>N>  OF  Tin:  IM;<>STATI:.   AM>   STOM:  IN   TIII; 

r.l.ADIH'.K       With  lu:;  \\  uod-e!i_  r;iv  iii_s.     One  vo!iau,.  svu.  .'l''^  pa_-e-,   uii:.-;i:i. 
1'ii,-,.  *:;.::>. 

"  \\  •     ar<'    u'lad    to    \Vficoiii'1    tin-    alile    COM--  op,  rat  ion  -   on    tin'   <_'et;lt<  i-tiri!i:i  r\    o'.an-.    and 

trilnition  to  American   siir-jical    literature.      It  having    l»-.-n    profoundly    impi.-s-.ij    win.   i.is 

i-    11,,:    so      xhaustiv      a-    ti.e   treatise-   of   Sir  eoii-uiniiiate   skill   iiinl   a"i:n\    a-    a    pra,-ti>ai 

Il'-nrv  Tlmmp-on  on  Strietui1     and  on  l,ithot-  surgeon,  we  hailed  v.ilh  ea'_r'  Tiles-  tin-  proini-e 

(,  iiy.  nor  doe-  it  iip'tend  io  Ke.  ln;t  it  i-  ;i  vt-ry  o!  a  M.OIII  _ri\i|iii  t'roii:  hi>  j"-n  on  :i  i-las-  ol  'h-- 

cli-.trl1.  -written    aii'l    [T.n-t  b'.il    L;"]ii'i,.   ainl    \viii  i  a-u~  t      whicli  ;n-  ha<i  _;i\  en    i-]n-ci;i!    at  (,•:;!  i.  in 

1 1      lo  ni'l     u-rl  ul    to         lar_'f   cl,i>-,  o]    ri-ailer-.  .     .     .       No    |  .1  a>-;  itioiu-r    who    nmli  rt  ak'  -    !  :.r 

I:s    in  •>-:ia:ii    .1     .xectiti"!!    is    \i-rv    cr'^iitalil'-.  tr'-atnn-nr  of  the   urinary  o:'_'ai.-   ran   alVor.  I  to 

an  i  it  contain-    ivmarka!  M  \    iVw  typo^raplncal  lie  witii    nt   it.      It   will,  we  are   conliol-  nt.  L;:\C 

error-."  —  /'//  "'<i>i<  'ii/iiii   .!/.//(,<//   /'/,,,  ,.s.  h;ni  a  nii;ii  p'^itioti  an;on_r  tin-   ri-cnu'iii/eci  ..  i- 

"  Ha\in^  on    liii],  rent   occa-ion-   iluiinu"  t.'ie  t^.oriti   -  in  !;:•    >|iec:ait\   with  wnicn  i:i-  inni,- 

list    six   ye.ii>    enjoy     i    th      |iri\ile_r"    of   wit-  has  li'-en  for  soni.- years  iiuiiuraljiy  a.-sociat.'cl." 

llessi.:L'    tile     piTl'orilKlIlCe   liV    1'r.lfessor   (eilll,-\        — '   tli'-UiJ'i    .)/'-•/-:<•.(.'    At»i. 

ul    .-nine   of    the   ino.-L   ditlicuit  and  important 


Fowler,  E.  P.,  M.D. 


Millard,  H.  B.,  A.M.,  M.D. 


•    |i   i~  ran    that   we   tin.l  a  Imok   so  evi.i.-nt  1  y  i.-    <\<  ei  i,-iil  \   oil"    of    t':ie    ti.-sr    lu^ks   ni"int!ie 

tin-    r  --Tit  of    caietnl.  original    stii'ly,  so  fresh  sullied  e\er  |i!iiiii^ne,i.  aiiu  no  one  can  n  ,M  it 

from  t  !!••  l>  -,|-i'le.   \\-e  may  -ay.  as   tin-  one   I"--  wit  noiit,  aitvantaue. "--'/'//,    .!/••/      >•'  !!•••• 
I'M]-.                   ];.  t  ,i.. ;:._'.     for     rea.-on-    \vlii, -h     lie  "We    l.a\c   -i'-iiveii    L.r:ea'    |i;--a-nre  fri  in    the 

sta'  ••-.  a  :i'  I  v.'  i leli  a  r"  MII  11  iM,  t  in-  genera]    term  perusal  ot    t  .11-   work,  a    i  l-.i-ur>    ,  n  l.anci  •!    i  <\ 

•  15ritriit'-  I  >i-  -a-i-,'  I  ne   antlior    mclinlcs  in  liis  t  lie  rea.ialii,'  typi- and   e\eei.,  n'  ,|\a  l:t  \   ot    the 

stnd'.'iiie    s.i'.!"1,-    form-    of    ir-|'!inti-.    \\li.ci:  jiai.i-r   up  m  wiiicli    it   i-   prime  i.      U  .•:;.•  i :  t  i!v 

s!ne.    t!i-  d,r.  -  of    l>i.    liri^ht    i:ave  K,  en   i  eco^  reeommeiid  it    to  the  public.  "       '•'-          '     /',•<• 

ni/.-ii  .1-  -i  tuple,  ac'i!  •  a 'id  cnronic,  mter-titiai.  i, ',-,,,•  ,-. 

CI-M  ipMii.-.     a'n.l      -n;.:,::ia' i  ,.•."     •    I'l,       .!/..-'.,,•'          ••From    st,in    to    st.-ni    the    1 kp:e-eiits:i 

«ii     s. ',--/-  •• i '/,'• /,.,,•'./•.    I'nil.i'li'lpiiia.    I'a.  practical    and     an    o:  i-inai     c:.aiae;.|     •:    it      i- 

"  'I'iii-    va  1  na  I.,,'     WMI  k     i  fi  int  i  in-     n  -arl\    all  t  nn\    i  •  1  r,  -innu  t-i   t  :i  ••  p:  act  .1  IM;..  • 

till',  i-    kiiown    I'M     r.-latiin    t.i    t.iis    m,,-t    fatal  >/</••'    I"     • /,    .!/•"'        '     I.'"  • 

,il--i-  Tni-    \vo;  k     1-     f.l!i\      iiill-t  I'ated      l,\  " 'Throe.^  ::ollt  t  i.c  Imok  lie  .11-1  •:  i'k - 

v:    ni  '-:it-.   wni'ii    ii'"   a'niM-t,    eiitireK   original  alile  lucidity  wi,icii  add-  .  ri- i  •'.'.     n   t:e    |'!e,s 

\'.  i' .  i   '  !;•    a  :t  h  >r  an  I  ai  e  '.  e:  y   aceMi  at  e      Ti.i-v.  mean  i   i  f"'  '   ii«Ti  \  rd   i  rom  a   pi  :  n-  , .  ot   :; 

a  Ion  •.   ji\.     r :.,-    read    r  a   v.-vy    fair    i  !•  a   of    this  '',-,,,,-/,/  '/'/••'  •'•'  ••• 
di-. ,.-...          /.'"'l'.!'',,    ['.I,,,*;, •;,<'„*'  .I,,. I    >--,•,;.,„,'          "  Dr.   .M;  laid    r. 

/         -'    /  •'  •/-.  t  ion  of    t  i.i-  ills,  a-e  i-.  a  y.'-rj   t : 

••'I':.,     p    :--:-al    of    t!:i,    li,,,k    v/il!    Piak-    the  eal    manner.       I;    i-    a    weriv  w  aich  amply 

\  o  :     .:   !•';•.-  '••!  i  'i     I  am  i ,  iar    w:t  !i    tin     lit  "1'at  lire  repa\    t  e:  ;;     i :      e,     a'  •.     t  :.•. 

a     d    '  ..era-  i-  .' les    of    IM-    di-ea-e    of     \\mcii    it  ','/,.;,/'     !.'     . 

t  '-e.i'  -    v.  !'  !i-.  ;'      ii'-ce--i!-it  in.:    a     laiiori'i'is     r---  ' '  T:  e   .1   . •  ii  ,;     i:  ,      w  it '•-•!    a-    •  '  ,     •••.      ,    •  •  ' 

s  arc  ,     tlno'iuh     the    n  nneroiis    Milnme-    tiiat  mil'.     '  na.-    t  ,,     e,,  ir.u--    .  f    :.i-    «]•  r.\»'.-.'    K-.t 

llll  Ve    liei-U    Wl'itte.l    on    tile    slllij.  Ct."         .!/"•'(•/•••;•.  ai-o   a-     i  •!!••      V.  :.o     p      -    •   --e.     I     .. 

"  T:.e     in!  \    i:e  r:-   t  !.e  a-i  tin  •:•  i-!ai:i:-   for  ti:i-  p:  •   •  -i'  .:  t  'em  i-    -    •  ,:  -•  \  : 

\\  ork     Is    t  iiat     i"     ji\ '  s    I'M.      i-' -suit     of     n.-ai'l  v  w,'il  d,  -•  r-.  "..    -  >t    IM.   t  i  •  ie1  ,•".:,,:    ,   :<    \   o!   t  :.•• 

f  \vi-nt  y--.-ix  year-  of  ;;o-pua!  and  |  n  vat"  prac  -  t'a-t   IMHIJ;   n.ak'-rs  ot  ;;...-  c.v.t  11:-  i,;   "-  '  'u  ,,,•.// 

tice,   and  oi    -eM-ral   veat's'  -fm\    in  !.';•    ]-.ii,,ra  /.•///   •:. 
t  n-\.       11     i,  .  ntitled  to  claim  muca  ,,„„-.  .       1; 


40          ITJJLICATInNS  OF  AYILUAM  AV(H)I)  A   COMPANY. 

/V.VM/.sv  .9    (if  (In      /\.f<ltll-i/f<,    '  /('. 

Dickinson,  W.  Howship,  M.D.,  Cantab., 


Charcot,  J.  M.,  M.D., 


i.r.rTriiKs  ON  BKK.irrs  DISEASE  <>E  THE  KIDNEYS,  DELIVERED  AT  THE 

xlKMiL    nl'    .MliDirlNE     (i I-'    1'AltIS.       Collected    an. I    ]>ul)lishe,l    l>v    Di;s. 

I '..it  I:M.\II.  i  i     ;nnl   SK\»TKK,  editors  of  the    /'/•"</'•<'.«    Mi'<Hi;il,  ami  translated, 

the  p-niii-sion  of  the  author.   l>v   HKM;Y   !'..   .M  i  I.I.A  I:D,   .M.D..   A.M.       Illtis- 

•.    :    "      v    two  colored    plates  an<l  with  wood-, 'n^raviiiu's.      One    volume,  ^-vo, 

1 1  'ii  |,;i_ ...-,   uiu-liii.       I  'rice.  S  1  .Till. 

"'I'    •     t:;;i:;k-    "i    th.'    ]•••  i .;.  --Inn    ;:re   i\u<-    t.i  "Whatever    mav     hi-    tlioiiLl'hi    "f    I'l'nffSxir 

•  .  ,'.-:it'r.     I  >r     .Miii.-ii.i.     for  the    \va\     in  C'hareot's  vu-ws  of  tile  xariiin.s  toini>  nl'   n-nal 

,-    ]..•:;,.!  MI.  ,i    h,-,    iiurtiidi    of   the  alteration,  i.diie   can    frl'iise    to   him  the   merit 

.     >    '        :    ;ii.i-hei-.-  li  .]•  t  in-  i'leai   t  \  pe  of   a   |  in  it  on  ml    t  Ii  inker   aiui   a   most  .-agarious 

..    lit      |ii'eai  ain-e  nl'  the  Ijo^k.      1 1  .-::.  u:  i.  1  ohs.Tver,     I  he     |  .|i  il.ix  iph  ]e     eiiaraet  ei'     of     his 

.     •  \  ..  lie  v,  ho  (ie-ii  e,  t  o  lie  ii,  tonne.  1  views  lieinu'  at    o]  ice  a  I'ecori  1   ( if  t  lie  kllowlecij^C 

•    •       ,v  of  !!•  ]-:.!'>  'I;-.  •;!-.•."      .]f,,;;,;i!  of  t  lie  da\   a  ml  .  >!'  t  he  geiiiiLs  ol'  their  autiior. M 

r,, ,,,«!',    I,,,     ,;t. 

I'll      ..••-•.,,.!,    ,,-  :l    ;  i.  u-      f      he  pat  h.i'O  •'  'I'll. •  hroeiillle  is  vai'aahle  enough  to  lie  wt'll 

'""'           f  ".i         • '-  • :  I-.-;,-"   a-  .-at i    I.  wort  h  i  he  s:  n<  1\  . if  e\  ery  Imsv  jn  aet  ition.-r  who 

i\va;,     -    ni.    nf   the   ol»enri  h:i-  a   lieu   ea  -••  .  .f  al  hum  in  n  I  la,  t  o  ma  na^i  ,  and 

\      i.i't.vi  to  el.inile.l   the   -tn>i\   of  it   \vill,  of  eotii'se   fim  1  a  place  u  pon  t  he  lihrary 

ih.ct'          /',.,//.•.!/--/„',-•;//,,/       •  helv.  s  of    e\e,\    one.  "-.I,  „,,•/.  ',<„    ,1,, ,/ ,' „  «l  ,>f 

':,  .]f,  .a,-.,:  ,s, ;',  „,-,*. 

Stewart.  L.  Grainger,  M.D.,  F.R.S.E., 


Ii    •'•'•"    forms  \\  ith  \\  hidi  the  name  of  Bright 
••ii-  in   e]malilv  ami  hoiiorahh   assoi'iated.     .     . 

"  'I'm     -i.li'ject     ;  !iroii--h,.i'it     i-    haii.lleii    I '\   a 
n    I    r    mji    1.        To    t  he     ^  nei  al     praet  it,'oner, 
anii     p.  i  :-i!l\    to    i  ho-e    Intel  e^teii    in    oi  -'  a-es 
-     oi     ;    .      l-ihiiieys,     t  he    win  1;     i-    in\  alualile." 
' 


Pifl'ard.  Henry  G..  A.M..  M.D.. 


IHBL1CATIONS  OF   WILLIAM.   WOOD  A    COMPANY. 


Vidal,  A.  (De  Cassis', 

A    TKFATISF    ON    \  FNFRKA  I.     DISFASF.S.       With    ,-oi    i-,-,l    p'.at.--         TMII-'.V.-,! 
\\  itli  annotation-,  liv  <i  i:ui;i.i;  (  '.   Hi.  \.  KM  AN.  .M  !>.,   I  ']•<>:'.--»,,[•  ..;  >iu_,  \-\  in  :), 

.M>  -liral    (  'dlli'iri-    c'!'    <  "hi"   :    SlllXf.'ll     !"     ill.-    «'<  .111111.  Tcial    lln-|.it.il    .      1   • 

i;..\al   M.-.lir.-il  ami  <  liirurji.'a!  Sori.-tv  i.f  LOIM..M.     OIL-  vulum.-,  vv.,.    I'.i'.t  ].;,_, 
luii-'iin.      I'ri'-.-,  st..")ii. 


Taylor,  R.  W.,  M.D., 


-VI'IIIMTK1   LKSIOXS  OK  THK  OSSKol'S  SYSTK.M  IN  INFANTS  AM)  Vnl   N<; 

(  I11LD11KN.      One  vi.luni.-,  S\-..,    IT!"  |o ...->.  muslin.      I'ri.-.-.  ^-J.:.n. 


Keyes,  E.  L.,  A.M.,  M.D., 


Diday.  Paul. 

o.N    SYPHILIS    IN    INFANTS.      Tran.-iat.-.I    l.v  Di:    C.   WIIITI.KV.      With  Not   >  ami 
A.l.liti.ni-  liv  !•'.    i;.  STfKtils,  .M.I).       \\'ith    a    .-..!. .i-.-.l    plat.-.         ..i-i    i.iilv  |.v  -nl,- 


Busey,  Samuel  C.,  M.D., 


Cazenave  and  Schedel, 

M  \NI\\L   OF    l)FSI-;\SI-;s   OF  Til!'.   SKIN:    I'r.-tii    ti,--    Kr.-:i.-h   ..;'    M  .M.  ( '  \:/i:\  \  \  i 
a:i.|  S.  ill  ni.l  .  wiih  i,..t.-- iiii.l  a.i.liti..!i-.  trauma!. -i  l.yT.    II.    I5i  i;i.i.--.    \1.|).    > 

i.ii-i  A  1 1 1- •!•!.-;. 'i  Ivtitii.ii,  . -n.ai  ji-'i  a  i  i.l  i-.iiT.-.-'.-.i  1 1  ..in  ill.-  ;a~:  l-'r.-n.-h  .-  i'.ri.>n.  \v  ::h 
^.i.liti.iiia!  n..;.-.-  L\  II.  I).  Ill  I.Kl  1.1.  M.  I)..  Phx-irian  ..!'  I!.--  \.-u  Y-i'k  ll.-).:r-tl  ; 
F,  l!,.-.\  ..•'  it..-  <,,.;,.._,.  ,,f  l'l.v.-i,-iaii<  an-1  S.II-..M.H-.  N.--.V  Y.-ik  :  I ..,';;.!  -:i  I  >i-- 

Livcing.  Robert.  A.M.,  and  M.D..  Cantab.,  F.R.C.P..  Loud., 


Wilson,  Erasmus.  F.R.S. 

Till'.    STI'DF-NTS    I'.ooK     oF    (TTANF.OFS    MFDH'INF     \\l>    I>M:\SF.SOK 

Till:  SKIN,      on-    volnn,.-.  Svo.    !!.">  i.ar. -.  in'i-'.i:!.      Pi :  ••-.  s:i  :,n. 


•l-J          1'IBUCATIONS  OF   \\1LLIAM   WOOD  \   COMPANY. 
'/'       /*'  /'<'/•*/ 

Fox.  Tilbury.  M.D.,  London, 


M\  1  \  !>I>I".  \>l>.  their  !>•-•:  i|  ti"ii.  Pathology.  Diagnosis,  and  Ttvatllicllt  Sec- 
,,,,,(  American  from  I  '•  I  !i  i"!:  r.dition,  re-written  and  enlarged.  \\'ith  a 
I  'u:. i-:. •,.-..-  I'han  •  ''  ns-urial  Index,  and  sixty-seven  additional  illiis- 

(  I:,.     \.'luiii'-.   v  '•'.    '<•'•'-    pa_e~,   muslin.        Price.    S.YOO. 

••  T    •    ...;-•      •   ;     i      •     .i         •    i  •    •  •  .•  , i     uli-     iNnos      Am.   I'll! i.  '.  \\ill    ini\v  find   its   sucees- 
.     un'   :•_•-.     and.     sor  launched  forth  a<  an  imposing  octavo,  lux 

•••:••  i.  nun-     urious  luitli  a~  to  paper   and  type.      This  is.  in 

.  •  •  ',     in,'!     our  opinion,  a  ui'eat    improvement.      \Ve   must, 

confrss  to  a  virt  nous  honor  of  pocket  manuals 

\  •  ,\\  •  '        •'  d  in  the     as  recall  i  ii^  d;u  s  when    medieal    .students  were 

-,  -."       /'/,,    /ht',/;//     less    sensible    and    industrious    than,   happily, 

i,  •  •    I/  tl,e\-  now  are.      .Not  only  is   this  volume   much 

•  \\  •         i,       :i,!ii.  i:'i    it  to  tin    stn-     enlarged,    luit    is    also   recast    m    parts  and   re- 

:  prai-tii-al  u'uide     written.    One  of  the  most  important  new  fi-:i'- 

oi    i:.     -'..  iii.  in  u  hirli     nres  is  t  he  addition  ol   many  new  illustrations, 

'     t    investigations     of  which  there  ai'e  now  nearly  one  liun<lreii    in 

;.•,-,  •  \   of   the-e  allec       the  volume.     The  author  has  taken  f,'reat  pains 

• .  i    •    •     pr.-i'-t  it  ioiier  it  will  I'Tove     to  include  i  he  latest  i  (  searches  in  dermatology 

i\    Iniok  <if  reference."     in  this  edit  ion  ;   and  we  ran,  therefore,  unhesi- 

tatii;L;!v  r<  ciinimend  the   hook   t<>    our   readers. 

••  1;    :  :  ci-.-.    and    practical.      The     \\'it::out  i|iie-tiou.  ii   is  now  the  most  complete 

:         •  ric::er   in  \  alualile   eon-     and   jiract  ical  wi  irk   on    cutaneous   medicine  in 

••.••';    i  u    the   subject  of     the    Ivi^'lish   lanuuau'e.      The   oi'dinary  student 

,'   ,',,,/    /.,,,//x  •///,      will    find    in    it  all    that  he  can   desire.'  and  will 

'..'  only  lie  led  I iy  its  tone  to  wholesome   methods 

••  \\i    v,      dd  advi-"  all  practit  inner- of   med  -     and  hiuher  flights  of  resoarfh  ;   while  t  lie  ]>rat- 

•    ( ins  practical  \vork  and   study  it."     tit  ioner  will  fall    hack  upon    it  s  resources  wit  h 

I/         .,'  ll-,;i',l  satisfaction  and  with  fresh   resolves."— Notice 

•  T    •  n      •      familiar    •  ii       '    ••    volume     of  the  ne\\  edition  in  the  l.»>t<l<n<  L«n<'<t,  l-'eli- 

i.   ::.  t  ie  furm  oi'  a  pocket    manual     ruarv  s.   l^T-J. 
:.n  :;,.  :   !•;  lions  w.  !'•    small,  t  iiick 

The  Pharmacopoeia  of  the  United  States. 

:     !'...  '     II. -vision.       P.y  authority  uf   tin-    National   Convention    for   Revising 

ti..      i1  i-;a    !.•':!    at    \\'a-hint,'t"ii,     A.D.    l^sn.      ( )ne  volunii',  Svo,  about 

i_     .     l.olllid    111     inlislill.        I'l'ii'e,     S-l.dll;      leather,     S."j.(l()  ;      leather 
•    •       i  vi    i.     S''.. nil.       I] id.   printed  oil  uiie  side.   !v.").(l(). 

•('        •      •       •       i;.i-i:    pro\    :n. -lit-  \\hieli   ap-     adulterants."      -  .!/,,/,',•,(/       f  '<,//;,  */  /,,/-,      (Irand 
;  -.•..-.    1  '.:••.  o:    i  ;  ,     i  -  ;  h-  -i:li-;  :        Itapids. 

•     •       '      '    •     '     •     uli    iiiea-r.iem  e!M-  of          "  Thi    National   1  'hnnnacopn-in    is  t  he  stand- 
',    N>  w  Vo:k     ard  authority  as  tome<lical  preparations.    'I'he 
pl'e-i-nt    r.  \  ised   i  d  It  ion   represent  s  the  lies!    i  f- 
I'i.armaeopii-ia     foi  Is    oi    tin-    liest    represi-n tat  i  ve    men    in    t  he 
•    '    •     ('ommittee     pharmaceutical  profession  of  our  conntrv   "-- 
•.      :     i-osm-.t   t:;.  ir  t  is!;    in    no     '/.,,., ;.,,','',      ]f,,li,;i!  \,  ,,-x. 

'    i">is         "The  committee  eertainlv  liave  lived   unto 
'   '  '  :.-    i  '    i   :  •:   vti  '•<•      t  heir  privileges.       T!;e\"  have  revi.-i  d  it .     <  'i  im- 
:      •':»:.!    ••'[••  r       pa ri-il  wit  h  l^T'1,   it   is  almost  ii   revolution.  Hot 
A.  •       a     -Iniple     r    \ision."     -77-      .\f«l,.;,l    .!-/,',,„,, 

Ann   Ar!, or. 

•         I'      r!     ,  -"p  '  :  •    prop-r,  "'I'!;.-  co,n!i.itt">;  devoted  a  little  more   than 

.     .     •    •  •       :.•••]••':.   v  ••!••'  -     t  wo  \  ears  to  t  he  wi  >rk  of  revision,  ami  the   ie- 

1   of  i  pi  11   lalnir  is    now    In  lore    us.      ()u    i-x- 
''.•"        '  niiiiu  iiiu  t  lie  woi  k  we  are  at   once  st  ruck  wit  h 

•  '         :         '         '  '.•    i:    | mr!  a nl    ditlen  nces    t  hat    exist     1>.-t  u  i  en 
:.•'.'•.  .        '  it     and     it-      predecessors.".      .lflf/i><i!     /,',-.,>•'/, 

-         .',  r  \    -.'i  i.    ]  ss;; 

"If.  on  i  In    i'li\Mcian-s  tal.le.  this  work 

I  ro;  i;ii  ]  -,    i»J  un  if     I  1 1  ipielit  ly  eon-ult''d  as 

•        •  •  '  i    •  i'  I    1 1      pi  eserii  iin;,'  t  han    an  v  of  her  btmk    ill 

•  •      '  '  •  f"r  if   repi'i  -'lit  -the  1 1  ~nlt  s  of   the 

•  '      ,i       :     '  '.  '  .     '  i''''-.a:  r-h.  s.          The    commi'tee 

•     '       \  ii!        \MI;  k   in  hand  deserve  ureat  eiedit, 

::.'li    .   1  lie   \:  ork    i;|i  to  t  he    pi  is. 'lit   needs 

••  }•'.:  .  r;,     '    •  dical    library    should    contain    a 
'  . '  r\   pi. a  t  maci-t  should  o\\  n  one.'' 
•  :  '  •    ';.'  •  •/,. 


PUBLICATIONS  OF  WILLIAM  AVOOI)  A   COMPANY. 


Edes,   Robert  T.,   A.B.,  M.D.   (Harvard*, 


THKUAl'KCTH'    HANDBOOK   ol"    Till:    I'MTKD    STA'IT.S    I'll  A  I,'  .M  A<  <  >l  'T.I  A. 

I!. 'in-  a  condensed  statement  of  t'n>-  I'h  \  -ioloj  ;,-al  and  Toxic  Action.  M.-di<;na! 
Vain--,  .Method-  of  Adtnini-tratio!!.  an. I  Do-.-.s  ..('  th.-  Dm.:-  aii.l  I'r.-parat  !..i,-  in 
th"  l.at.-.-t  lid  it  ion  of  tli.-  t  'nit>-.i  Stater-  I'hanna.-opo-ia  i  A  pot  h' -oar;.--'  aii.i  Met!  •;•• 
S\>t.'ini.  with  sum.-  remark-  on  I  iiollioinal  1 'reparations.  Oin-  volum--,  >vo, 
;iun  pa-es.  muslin.  1'rin-.  !>o..~>n. 

*  -       'I'll.-  "  H  \  MH-.OI  IK  '  ir  TIM:  I'sn  i:i>  Si  vrr.s  1'n  \I;M  M  <ir<n  \  "  is  intcn.it-. I  t •<  lie  a  i •..;:, 
mentarv.  t' I'm n  it  medical  rat  he r  than  from   a  jiii.inna.-.'ijt  i--  iitmit  t>t'  vit-w.  nj.tiii  t  h.-  iat.-st  .-.ii 
tiuii  i).   that  wiirk,  which  i>  ju.>t  cDinp.i-tfd.  ana  w;ii.-ii  nmtuiur,  jnany  inor.-  chaiiu'i:.-  tliaii  h.i\>- 
l.vt-:i  mail.-  in  any  .if  tin-  ].n/\mi:s  1 1-\  i^iotiv 

As    th.-  I'iiariiiacnpci-iii   now  stands,  it    iv]>n-M-nts  a  \  ei  \   .  -\t.-n-;i  \r  phannaceiit  i.-   ain:a".-n 
t  u'i-nn.  t-iiiiirai-in.;  all  t:n-  inijioi'tant  illtruiliii'tions   to  tht-rai'i-'itics  ol    tin-  la.->t    t>:ii   ur   i'.-:h,i|.> 
t  w.-nt  v  y.  :ti--. 

It  i-,  i  vi  l.-nt  that  a  foni[ilt-ti>  trcatisi.'  tin  tlicraj't-uti.-s  is  not  to  l.t- looki- i  f..r  in  a  work  of 
l\i i-  -[•<•.  i-vi-n  il'  t  !n-  aiiti;or  IV! t  himself  i-onlidi-nt  to  \\  riir  om-.  lint  it  has  lici-a  h  >  aim  to  -::..w, 
as  Miccinct  !\  a^  is  consistent  with  ck'arm'ss,  what  c  i.-ii  di-n^  can  do  in  tin-  tn-  itim-nt  .  f  d;.>- 
ca-.-,  what  it  null/  .lo  if  not  caivf'dly  n^t-d.  and  ho'.v  far  tin1  varion*  jii't-j.arat  ion-  air  tittt-d  to 
tlisj.l 'iv  it-,  i-f'in-iiia!  powers.  \Vhik-  tht-.nies  cieeti-d  ii|>on  .-!>•!. di-r  foundations  hav.-  l..-en  ^t-n- 
erail  v  ne.:le.-t^d,  tin.-  ]ili\  stolon-leal  act ion  .it  dnms  has  In-eii  f,tatt-  I.  in  accordance  wit  h  n-.vnt 
in\  e-;t  luat  i.ui>.  MI  far  as  it  hears  upon  tiieir  practical  u.-cs  and  upon  t::e  s\i!ipt.im.-  and  tieat 
in.-nt  i'f  p.  ii-oiiin_,'  which  mav  In-  occasioni-  1  liy  tln-m.  Thi-  knowlt-  l_re.  -..  far  as  .litainalile. 
while  it  can  iicvt-;-  supplant  t  i'.e  linai  te<t  of  car.  f'll  and  unprej  ndieed  clinical  oliscrvat  ion.  !> 
of  tin-  iitnio-t  innii  it  nice  as  a  iiasis  for  the  rational  KM-  of  dm.,'",  and,  especiallv  so.  as  a  step- 
pi  :ur-stone  for  tin.-  ad\anct-  of  therapeutic  -ci.-nce. 

Much  a:ti"iti..n  has  Keen  paid  to  tin-  very  important  snli'rct  of  dosau'.-.  and  while  ti'i- 
en  It.'aviir  has  IIC..MI  to  err.  if  at  all,  on  the  side  .  >f  >afrt  \  ,  t  lit- neci-ssitv  of  pnnlncini,'  in  soint- 
cases  iihviiins  effects,  jf  it  is  tlesircd  tt)  ^ret  therapeutic  re-nil  -,.  has  not  lieen  nverlooked. 

It  i-  hope  1  that  this  lunik  will  lie  found  !>\  the  ph\sician  a  t  rust  wort  hv  u'ldoe  in  ntili/iriu' 
the  agencies  wid'-li  the  1'harinacop.ria  places  in  hi>  hand.-,  arid  liy  the  pharmacist  a  luief  and 
inte'digilile  ntateinent  of  what  may  In.-  expccte  I  from  tlic  siilistance  he  dispenses. 


Thomson,    Anthony  Todd,   M.D.,   F.L.S., 


A  mNsi'Krrrs  oi"nn:  IMIAII.MACOI'M'.I  \s  <n--  THK  [.ox DON,  iiniNr.i'K'.ii. 
AM*  Di'iu. IN  c( >i.i.i:<;i-;s  oi-  IMIVSICIANS  AND  sruci'ioxs  AND  or 
•nil-:  r.NiTKD  STATI-;S  IMI.\I:.MA<  <»i'<i:i A  •.  r,r.i.\<;  A  IM;  \CTICAL  COM- 
ri:\  DII M  or  \i  ATI'.IMA  .MI;DM  \  AND  IMIAILMACV.  i:d;,i.  i  i  ,  •  n  \i;n  - 

A     I.!  i  .   M.D..   I'm)' r  of  C.'ii.-ra!   I'at !,,.!. u;    and    Mat.-ria    M.'dica'in    C.-n.-ial 

M-  ii.'al  ( '.i !  l-'-'i-.      On,-  v..l  n  1 11.-.    l^iun.  '.\'1'1  pa_.  -.  niu.-iiii.       I'ri.-.-.  s  1  .(in. 


Footc,  John,  F.R.C.S.  'London). 


•nn:  i'i;\<  TiTioNKir 

(  '.  .ii'.ii  niiu   t\\o    !  h.  n 
the  in  o-i   cm  i  in 'ill    I  Irii  i-ii   and   I'oi'.-i    n   ni.-d  ;.-,ii  ant  i,.  .:•:'  i-1-.  "' .  •  .  .  t.-        \\  r  i,   .1  : 
ti..'  -    l.y     P.l  \.l\\ll\     \\  .     M<  (    III    Mn.     M    D,     I':-.. I--.--  .     .Ma:    :        M.-d:.-a    a 

I  'iii  i  m. a.  -v   :  :i  th.'  (  nl  !.'._!•    n.'    I'hariuaev,    N'.-'.\~   \  .  'i  k.  .',.-.       In    oif    1  'Jia.  •  \ .  ..ni 
Ii'.i  i  ]M_.'-.   m  ii-'  i  n        I'ri.-e,   S'J  i  ii  i. 


Johnson,  Laurence,  A.M..  M.D., 

A  MKDH'AI,  roIl.MrUAUV.      Sold  ..n!\    l.\ 


44          I'l  T.L1CAT10.NS  Ol'  \\ILL1A.M  \\OOJ)  A;  COMPANY. 


Oldberg,  Oscar,  Ph.D., 


Wall,  Otto  A..  M.D.,  Ph.G., 


A  m.MPAMoN  T<>  TIM;  r\ri'i;i)  STATKS  PHARMACOPOEIA,    pen^-a  com- 

i!,.  -itrirv  nil  •': .••   !...'•  -'  Kdi!i"ii  «'.'  the  Phannaenpu'ia.  and  containing  tin-  l.'escrip- 
l'i ,  >i  ..•!  •;;.•-.    1  'M  -s.  and   hoses   of   all  (M'icial    and  niin.eroiis  1    notlicial   1'nm's 

•  i    Pr<  ;   .:•.:-    in    eiim-nt    u--.-    in    th^  I'nited  States.  toL'et her  with    Practical 
Ilii.--..   \\nrl\m_'  I'i'i  inn',  a-,  t-tc. .  doiiriinl  a>  a  r^a  ly  i-ct'»Ti  •!!<•»•  In  ink  for  Pliai  ma- 

•       p]     -         us,  and    Students,  \\i:h    nvri1  :!()(•   oi-iirinril  Illustrations.      Piici\  in 
s in!     ith.-r,  Sii.OO  :    in  liall  inorn  .-u,  S(i. ."»(). 

'I'i.i-    "  I 'i  iMi1  \MO\   'in    IHI:   1'si  IIP   S'r\'ir-   ]'i!  A  KM  w<  ii'<i:i  v  "   jiivcs    sucrinrtlv  the 

,iji,ij\ins     iM-ludin^'  all  roinnii'ii   nrlnral  l'Jiuli>h.  togothcr  with  the  < icrnian,   Picnch, 

rind   >\M'  ii--!i   iiaincsi,  uri^in.  lial'it'it.    dc.-i'riptiuli,  varii-t  irs.    Milist  itut  ions,  adnltcra- 

•  •      ii  lU-l'i   't--.   marks  nl'  'iiiality.  ]•!'«]  rrtic-.  uses  aud  dusi-s  nt'  all  the  drills  and  rhein- 
;    .iN  "'    w:.:e|i  .t   tre.it  ^,   ai    '.      ndel    each  dl'llj-T  nl1  chfinieal  will  I  n-  de^i-riln1  1   its  several  Jirejiara- 

•    •  • .  r  :;.a'\i:i.;   I  i  e>e. 

A'.!    '•  ;..:.'  di     •  it<'    i|t;autil  '»•-.  solids   liv  w.  i^iit .    ami    iiijuids   generally   liy 

••..  i>  .1.-,  ilie  "tli'-ial  l'»niji;las    in  ]'ai  t  -  li\   ueii^ht  j  l:a\  i:i.^  lieen  t  ran  si  a  ted  aceui  at  eh   a  coord  ing 

'I':  i     •     nk   t   ,ii-    -ir\r-   a-    a    ke\   and   c   :inrii:;-n   to    t  he  Phaniiarojiu  ia.      It  t;ive«  only  such 

i:,l".  •!  •.'  .it  •  n  a-  pham     '  i- 1  -  an  i  plr  -ii1  M    -  n.o-t   rrei|i:ei!tiy  ha\e  cu'easioii   to   put    to   pi  at  tiral 

•    i-i         id\    \  oca  t  ion-,  aud    i.i'iu-e    let  inical  de-n  ijit  ions  nf  jihtnts,  except  of  the  ] 'arts 

:  |o   i -.si  s.   a  i  en  ,ut  -  '  I   t  i.e  I  >h\  -i"  logical  ;irt  lon~   oi    7nei  li.'im  >,  etc  .   are 

r-'iati      ii      ia\i      •••!  r.iii>idereil  latlier  with    retercnc.'  to   aetaal  eoll- 

ol   t  i.e  :  i  ade  ;  i,d  t  he  practice  ol'  t  i.e  pro! .  -s>ii  m  -    cancel  lied  than   I  rum 

- ,      • 

h    ,          ••.•••<  nd  a   reliab'o  and  I'oinplcti' pharmaceutical  ami 

:,  •  a   practical  and   relialile  LTUiile  ill  tile  i' ientitieat  iull 

\\     •         •  '        •'.••'•'  ,.'•!-    are  aci'dinpanied  liy  illllstratiolis  whic'h.  as 

|  eci     •          r'.ei:    to    t!.i     fa    simile   I'eprodiicti >\    the   detail^  of  the 

.•  it   11    •  •  •        •     .        ••          r-1  shown  1>\   the  figure-;  are  not  re|  cate  I  in 

'     •      •      '  •          •  •  .          i  .    .'..•..   el  c. 

iiMMinn          over  t  \vel\e  hi]iid re  1  p-i.ues,  illitstrntod  liy  more 
•     .  '        •       .       -  'irawn  from   nat.,ie,  printed  on  line  calendered 


Rice.  Chas.,  Ph.D., 


r'h  tr.'irv  M<_,rn--  which  ieme  lies 

•  •:  -.     which      i  e.|iiive     rant  ion.     and 

in   '   i  -        The     iii  i-e^    are    ;-i\  en    ill 

1      a  ni  I    a    !  il.le   tor  eonvel  t  - 

'      :     .    ::  et    i,-  - '.  -tern    i-   api  ended." 

.      -      •:  •   •'  /.:,,.„•/•,: 

h  h:i«  I.een  prepared   with 

1  i-  admit,.  I.  ly  adaptfd 
'•-    tor  ',•.  hii-h    it     i-    designed."— 
<>  J.j., ,•„.,!. 


PUBLICATIONS  OF   WILLIAM    Wool)  \   CoMl'ANV          -L> 

Hii'irt*   <>f  I>rn<i*;    ( '/"  in  ixt  rii.    rictnr'*. 
Lewin,  L.,  Dr., 

THi:  INCIDF.NTAL  KFFKCTS  OF  Dl!F(;s,  A  I'll  A  KM  A<  ol.oi ;  K  •  \  I,  \ND  CLIN- 
ICAL HANDBOOK.  Translated  by  W.  T.  A  \.\.\  \  M  >i  i;.  M  D.  On..  ..lum.-, 
Svo,  'Jo'.l  pa.;.'-,  muslin.  Price,  X'.'.dd. 

"That  in.ih  i  duals  vary  in  t  heir  MIS  rep  t  ibil  -  1  elmmim,'   to  t  iiis  eate^orv  abound  in  tin-  n  e  i 

ity    to    drills,    and    that    idiosyncrasies   of    the  ieal   periodical.-!   aim    in    the    unuiitten    .\ie:i 

mosi    une\p<-.-te  1    character    icveal  themselves  enee  of  doetoi  s,   but    Dr.    Leu  in    i-    th.-    l.r-t   To 

in    practice.   a;e   observations   of    \er\    ancient  make    a     b.  ok     by    colic. -tin.;    and     c!.;--i   \-i;_' 

date.      So  startling  are  tl:e-e  accidental  ellects  the-e  data.  a:-d  addinu'  to  them   his  ou  n  .  h-,-r 

that    sometimes    tleir    cause    is    apt    to   escape  \atimis    sharpened-  b\    speeia!    studs.       He    -I 

detection.       \',anations    m    the    phenomena     of  M-r\cs   ciedit    I  or  br.-akim;    new  LTiound  i:    the 

disc.i-e  an-  not    mo;  e   common  than  variations  tir-t    phi.  e.  and   in    t  i.e   sec  >nd  tor  an  not  at  :i  _-. 

:n  fie  in-!  ion  of  drills,   depending  hir^elv,   like  wit  :i  admirable  judgment .   t  his  somewhat    neu 

the  di-ea-e.  phenomena,  on  the  acquired  or  in  lectcd  br  '.nch  of  kin.u  Ied0e.  "  —  /.<»<  ,.-.<  , .",    .I/-  ./ 

iiented    peculiarities    of    the    patient.        Facts  (>•(/  .V- <''•.-, 


Witthaus,   R.  A.,  A.M.,  M.D., 


A  TKXT-r.noK  oF  MKDlt'AL  ( 'I  I  KM  ISTI1  V.      I'riee,  iniislin,  >;:',.  :ii). 

••  \Ve  do  not  hrsit.-ite  to  r-eoiiinieiid  this  "  The  author  IKIS,  \vo  tliink.  sueeec-ded  fairly 
work  to  till-  jTot'essioii  ;i~  a  emnpiete  text  --1  look  in  pi-e~eii!  ini;  wl.at  everv  iiraet  itioiier  .-i.i.iild 
on  the  di>e;i.-e>  of  uhich  it  treats."  —  Mniii'iil  know  of  tin-  si-i.'iie.-  of  eiieiuist  ry.  "  -/'/,/'././•/- 

'/.-.'•.-(//-.  j,/,;,i  .]f,,/;,;ir  „„,/  >//,•,/;,,,/  /,-,  ,,',,,•/<,•. 

KSSKNTIALS   OF  CH  H.M1STU  V,   Or-unk-  ;uul  Inor-ani.-  .  Wood  V  I'oeket    .Manual-  . 
I'lier,    Si. (Id. 


Draper,   John   C.,  M.D.,  LL.D., 


A    PRACTICAL    LAP.OKAToKY     CoIliSI]    IN     Ml'.DICAL     Cl  1 1'.M  IsTU  V.      One 

\-oluine,   oldonir   Ivlmo,   71    pa^i'S  interleaved,  mu.-iiii.       I'riee,   Si. (id. 

"Th.-  book  contain-,  in  a  concise  and  srien-  turn'  is  liini'e-1,  and  who    desires   practical    re 

title  form,  all  upon  the  above  topics  tliat  is  of  suits  with    tin-    least    expenditure  oi    tiim-and 

pra.-t  n-iil  value  to  t  he  pn\  -iciau.     We  cordially  labor  and  wit  hunt  the  aid  ol"  an  in-t  ructoi  ." 

recommend    it   to  ph\-ieians    and   student-."-  -  C/(.V,f//,i  .]/../;,.<'    '//,/, /.v. 
.lAWiA/'/./o'    V.,1',,',,    )/,,/;,-,,/  M,,nll,l;t.  "Tins    little   uork    comprises  what  a    your- 

"  In  priiitin.;  ill  •  I k  every  other  pai,re  has  doctoi-  oii^nt   to  know  about    chemistry  for  his 

been    left  blank  in  order  that  the  student  may  patients' uood."    -  /,'^l'n  '"  M- ./.,//,/ \,, ,-,/./,,/,,-. 
be  enabled  e.  .n  \-eii  ienti\  to  record,  in  n  s  prop,  r          "  1 1   i-  bnund  so  as  to  op.  -n    from  the  top.  so 

place,  th"  results  of  the  experime    Is  he  makes,  as    to    easilv    lie  open    on    the    table,    and.   a-    it 

and  of  additional   fact  s  obtained  from  oral    in  lies  open,  the    Io\\er   paje    ha-    been  left  blank 

st  ruction."       \!!'inf'i  M'll'-'i'  /,'ti/ixti  r.  for  an  \   notes  and  addit  ions  which    thestu.i.-n: 

"  I  iii  I.-,  d.    l.-\\   books  combine  so  much  I'-cful  desip  s  io  n  iak.    as  lie  pr,.c,-e.l-  -A  ;t  h  his  u,.rk.  " 

inf. n  m  iti. .11  in  such   a    compaet.corrcct.com-  -     /,,',,,,,!,,,<    \[,  ,/;,•..'./,,/.,•,,,' 
|ir--he:isivi'.    and    applicable    manner."      .I///'/'-  "The    -indent    is  indeed  to  he  coiiL'iat  ulat.-d 

"Tiiis    excellent    manual    is   one  of   the  best  prepared  b\   a  teacher  of  Dr.    Diaper's   i  xpi  n- 

e.\r  I'll    for    tne    student  or    praei  it  ioner  whose  e'l.-e."       /'/,.    .!/-./.'•./'.  |./.  ,   Detroit. 

Pictures  for  Physicians'  Offices  and  Libraries. 

F,.  I'.vard   .lentier,  tie-     Fir-t     Inoculation   of  Tli,-  Village   Doctor. 

\  a. •cine.    Mas    1  hli,    I71M).  The   i;,- b.-lii, ,n-  Patient. 

\:idr.-\\    \.-a!ius.theAnatomi.st.  Study  in    \nat. .IHN. 

Spootitiil    Lvi-rv    Hour.  \\'illiam    Har\-"V   i  'elm  .n-t  ra!  i  n.:   th"   Circn- 

Tii"  -i  •!<   Wife'.  latioii  ,,;•  the'p.l 1 

.-    Par.''    D.-mon-tratin.:    th"    Fse   of  The    \natoinical   I. ..lure. 

Li_:itlireS  The      \ccidellt. 

Tin-   Voiin-   Molh.-r. 

Si/o  o!'    ea.-h.    I'.lx'.'-l    inches.       Price,  each  ^^.  (Id.      Catalogues  of  t  lies"    pi.-'i.r.--    \viil 
be  .-"lit    up. c.i   appli.-al  ion. 


1'IT.UCATIONS  OF  YYILLmi   AV(M)J)  \   COMPANY. 


Parkcs.  E  .  M.D. 

A    M\M    \l.     oF    HlAtTICAI.    imUKNK.      Kdit.-d    l,v    F.    S.    It.    V\\  \\<  ois  I>K 

(  ii\i  Mi'Ni.   M.l'       si\:h  edition.      \\iili    an  Appendix.      divine   the   American 
].ra.-:ii-e  in  inatier-  r-  •laii:;_'  I"  hy-ieiie.       Prepared  liy  and  under  the  supervision 
!•:   I  KI  IM  KM  K    N.  (i\\i  \.  (  ivii  and    Sanitarx    Fnuineer.      Two    volumes  in   one, 
.  .  '.'  1'i  p.i_.  -        ll'n-t!    •  ine    full    pa--'    plates,  and    line    wood-em:rav- 

i:._  -.  mii-lni  I'in.lin  ..       Pi  ;.  .-,  s.",.  no. 

Stcrnbcrg,  G.  M.,  M.D. 

l;\i  Tl'.KI  A.  T.v  IM:.  ANTMIM:  MM.NIN.  "f  I'aris,  and  C!  Kdijci:  M.  STI:I;M',I-:KI;, 
M  I'  .  I'  I!  M  S  ,  Ma;«r  and  Mir.e,,n.  I'.  S.  Army.  One  vol  nine.  S\-o.  -1H4  j.:ii.'fs. 
I  ii-':  ','.\  \\i-li  :•.'.>•-••  l'iill-j'ii.i:i-  I'lafe-.  ini-iiuliiiji  lidioty  JH.-  and  litlmerapliiir 


Stcrnbcrg,  G.  M..  M.D. 

M\I\IM\    \M»     M\l.  \1M\I.    DISI;ASI:S.      Din-  volume,  Svo,  JW2  i>ag«-s.      Muslin 

:  >i    Id    1    '.     -ill'-i-l'ilitic'll    I'll'.V.         Si-.-    pa^e    ->'J. 

Sturg-is.  F.  R.,  M.D. 

MI'.l'H'AT,  Tol'K'S.    •  --•  •  1.    Hint-  and  SinrsrostionP   for  liefonn  in  M.-dical 

!  '„'.    A   I  !i-a    rurltp-   >la!r    Ke^  niat  iuii    of  .Mcd  icinc   and   Snruci-y.      :\. 

^}•    :  I    :     .,-•-•!:     It.-  I  M.'.-i  -i~  and   I  !<  ••  )  ii  i  i  -nil  -nts.      (  )n<-  vuluinr,  S  vu,  111  jiaet'H, 

Visiting  List  'Medical  Record\  or  Physician's  Diary. 

i  •  •  features  n|    [ii'i  vinns   iMiMicaiiuiis  of'  tliis  sort.       I'riees  : 

I         •      •  •      |.al  -  nl--  .1  week,   ha  in  'IM  'ine  p-d  ,,r  hlaek  leatlier  binding,  wallet  >t  vie, 

i    !e.-,    sl.'J.V.    t'nr  sixty    jiaiii'iits  a   week,  same  stvle,  \\ith   or 

'  lie-.     S  1  .  Til  I. 

Hun.  H. 

\  ',i  IDI;  TO  \.\II:I;MA\  MUDICAL  ^TTDIIXTS  i.\  lirnoi'i-;.     Price,  si.  o~>. 

Steel.  J.  H..  M.D. 


Buck.  A.  H.,  M.D. 


Hospital  Plans. 

i  • :  \  i :  i :  -  -  \  Y  s  i ;     •       •    •      <    •   • 


Johnson  and  Martin. 


\TF.S   ii\    i;ri;opi;AN   CON^TITI" 
.i  \  M  i  -  I!  \  \  \  I.D  MA  in  i  N.  I'--].     Fi  "in 

ph  \  -iejaii.       <  'lie   vol  ii  me, 


Kirby.  F.  0..  M.D. 


The  works    enumerated    on    the    following 
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MEDICAL   JOURNALS 

I-r",I.ISllKI>    BY 

WILLIAM  WOOD  AND  COMPANY, 

.~>(\   ,-iiitl   f>:s    I ,,- 1  f;  ivc-t  t  c>    I'l.'ie-o,    Xc-w    Vorlv. 

THE  MEDICAL  RECORD. 

A     ff'tc/>lif   ,/onrntif   of   Mcdicint'   and   Suryei'y. 

Edited  by  GEORGE  F.  SHRADY,  A.M.,  M.D.,  Surgeon  to  St.  Francis  Hospital,  Consult- 
ing Surgeon  to  the  Hospital  for  Ruptured  and  Crippled,  New  York.  Royal  octavo. 
Price  45.00  a  year.  Circulation,  over  half  a  million  copies  annually, 


TIIK  MF.mr.u.  Kr.roun  is  tin-best  known  and  most  popular  medical  newspaper  published  in 
th''  tinted  Slates.  It  presi  tits  a  faithful  weekly  record  of  tin-  existing  state  of  Medical  Science 
throughout  ;h'-  world,  and  in  consequence  of  its  high  scientific  character  and  practical  value  lias 
gamed  :he  countenance  and  support  of  the  profession,  to  the  extent  that  it  may  be  justly  consid- 
i:,  d  Hi-  representative  medical  journal  of  America. 

N-n  d  weekly.  i;s  form  and  arrangement  permit  a  rapid  and  satisfactory  perusal  of  its  con- 
tents—a  feature  in  scientific  literature  which  no  one  appreciates  more  highly  than  the  physician, 
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Tli-' information  contained  in  its  columns  is  of  the  most  practical  and  reliable  sort,  always 
keeping  in  view  thr  requirements  of  the  general  practitioner,  and  maintaining  that  standard  of 
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Illustrations  of  a  superior  quality  are  introduced  in  the  text  whenever  necessary,  and  excel- 
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T  H  33 

AMERICAN  JOURNAL  OF  OBSTETRICS 

And  Diseases  of  Women  and  Children. 

Edited  by  PAUL  F.  MUNDE,  M.D.,  Professor  of  Gynecology  at  the  New  York  Polyclinic 
and  a:  Dartmouth  College  ;  Gynecologist  to  Mt.  Sinai  Hospital :  Obstetric  Surgeon  to 
Maternity  Hospital :  Fellow  of  the  Obstetrical  Society  of  New  York,  and  of  the  Amer- 
i:a-i  Gynecological  Society,  ef..  etc.  Collaborators  :  in  London.  ROBERT  BARNES, 
M.D.  in  Berlin.  CARL  SCHROEDER,  M.D.:  in  Paris,  PIERRE  BUDIN,  M.D.  Octavo. 
Price.  $5.00  a  year,  in  advance. 


ThU  Journal  is  pr.  -i  miiiently  th'-  a<-c  -pted  organ  for  eoimiiunieations  in  its  scnpo  :  the  original 

-.  '      •  -  wtip-h  have  appeared  In  its  pages  include  many   of  the  most   important  contributions  to 

lie  dlc.il  lit.-rature.     1  very  available  means,  which  a  liberal  outlay  of  money  could  employ,  has 

tieen  devo'ed  to  its  copious  ill ust ration,  and  it-  prcsen;.i;ion  in  a   form  of  typographical  excel- 

qual   d  '<•  any  in*  'li'-.il  journal  ITI  the  world.     Much  of  the  success  of  the  journal  is  due  to 

•  .  satl-faetory  management  of  the  d.-pa:  tni'  11!  of  i  ib.-t dries  and  ( ',\  n ecology  by  i>r.  Paul  F. 

M  .:   1  .  ati  1  !.i-  L'-  n>  :a!  supi  r\i.-|on  of  all  th-   literary  matter   in   his  capacity   as  editor-in-chief. 

Tic    lepart  men;  of  Disease  s  of  children  recel\  i  •;  Hi--  r\:  tent  ioi,  which  that  t.rancli  merit  sand  which 

I-   r.    ini]      tant   f-  ature  of  the  journal.      The  assistance  of  the  distinguished  gentlemen  whose 

n.uit'-s  ari    as-;., elated  with  that  of  iheediro;    a-   collaborators  serves   as  a   further  assurance,  if 

i  f   the  u-'fulii'--;  of  tin-  journal,  and  N  the  result  of  an  arrangement  which   was 

ma  le  i1.  view  of  the  extensive  foreign  circulation  it  ha-  acquired. 

TII-:  .\MKKIC\N  Jof-i;su.  in    (ii;s-ri-TKics  has    li-J  pages   each   number,  or,  1,.'U4   jiages  In  tin; 
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TIIK  . \MKKH1  \v  JofHSAL  UK  Ous"i  LTKK's  "ill  be  H'lit  to  pald-uji  subscribers  for  the 
I:KC  li'.i   f'.r  fJ.i'i'  a  year. 


Journal  of  Cutaneous  and  Venereal  Diseases 

(ISSUED     MONTHLY  . 

Edited  by  PBINCE  A.  MORROW,  A.M..  M.D.,  Pnfessor  of  Veneretl  Diseases,  Uni- 
versity of  the  City  of  New  York  Surgeon  to  Charity  Hospital  ;  Surgeon  to  the  Bureau 
of  Outdoor  Relief,  Bellevue  Hospital.  Price.  $2.50  per  year. 


The  diseases  which  it  is  thr  object  .if  tin-  .JoritSAi.  to  embrace  are  of  n\\<-\\  manifest  Interest 
anil  importance,  and  occur  with  suillcient  frequenev  in  tlii-  practice  of  every  pliysi  -i.in  to  warrant 
their  special  consideration  in  an  appropriate  ctianiii-1.  At  tlif  present  time  there  are  live  j  .urnalfl 

ileVilteil  tn  these  subjects,  this  lirKIJ.'  tile  only  n!u    ill  tile   IJltrli^h  lallflaje.      It  i-  intended  I..  Serve 

as  a  meilium  of  communication  between  those  \vtio  have  u'iven  si*  eial  attention  to  the  subj.  ets 
referreil  to.  ainl  those  numbers  of  the  profession  in  y;  rieral  praeti.-e  whose  time  or  opportunities 
will  not  permit  them  to  eii^a^e  in  these  special  line-  of  investigation.  In  carrying  out  this  aim. 
it  is  tin-  intention  of  the  publishers  that  the  .TOVHNAI,  shall  tie  eminently  practical. 

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the  MEDICAL  RECORD  or  the  AMERICAN  JnriiSAL  OK  OISSTFTKICS  for  J-.'.IKI  a  year. 


AMERICAN 


An  Illustrated  Journal  of  Pharmacy,  Chemistry  and  Miiteria  Medico. 

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A' ttu- d>»ir>' IIIT  r.iti-.tnn'ij   >r  >,,  n  ]ii,:!n,   mlr.in,;     ',)    Willi-mi  II'.,,,.;  ,f    C,,I;I;M;,  \j.  ,,r 
A>jt*nfii,  A'Or  tfu-  IftuU: 


REFERENCE     HANDBOOK 

i'F    THK 

MEDICAL    SCIENCES 


MK>SKS.  \VII.I.IAM  Wool)  ,\  COMPANY  beg  leave  to  announce  to  the  Medical 
ProtY.-,s;i.in  of  the  I'nited  States  an  1  Canada  that  they  have  for  several  years  past 
been  or_-am/.:ng  ana  arranging  '"''  the  pr'-parat  ion  ol  a  \v<irk  differing  from  all  others  here- 
tofore puh'.ished  in  t  his  country,  and  calculated,  as  they  bciieic,  from  its  character  and  the 
i'.ijh  reputation..)'  its  very  laix'1'  stall'  of  learned  contributors,  to  l>e  the  most  practically 
and  generailv  useful  \vnrk  to  all  classes  of  tiie  Medical  Profe.-Mon  of  any  hitherto  presented 
to  t!u>;r  unlive. 

1:  i*  des lulled  t  ii at  t  Ids  super!)  work  shall  cover  so  wide  a  field,  and  embrace  such  a  great 
variety  of  topics,  as  to  make  it  of  tin-  greatest  practical  utility,  nut  only  to  th*  <ji  ttt  nil p rn<  - 
titi"!if\  hut  'i '.so  ,'  ,  thfXi  who  are  !  >itertxti'd  more  particularly  in  siigi-iul  dijtartmenls 
of  medical  knowledge. 

This  work  will  consist  t>f  a  collection  of  concisely  written  i  ssays  on  all  the  Impor- 
tant Topics  )><  long  i  lit;  to  the  Hroad  Domain  f>f  Medicine.  Its  subject  matter 
will  lie  il]  liaheticaily  arranged,  thus  admitting  of  instant  and  ready  reference,  with  no  losa 
of  ti:ne  ;u  reading  over  pai;e  after  page  to  find  the  prec:::e-  item  desired. 

T:.e  number  of  those  phy.-icians  who  take  an  intere>t  in  the  more  purely  scientific 
branchi  s  .if  ir.ediral  knowledge  is  already  ijiiitc  large.  a:id  will  undoubtedly  increase  as 
time  ^iH's  on.  It  has,  therefore,  hern  thought  advisable  to  tln'otf  coJitidcrablc  x/xjiv  to  the 
more  inipdrtant  topics  lirlonu'iiiK  '"  the  domain  of  Anatomy,  Embryology,  Histol- 
ot;y,  I'hyxlology,  rhysiolot;icul  and  1'a  t  holo^icul  (  luinist  ry,  Patliological 
A  niitomy,  C'liiuutolo^y.  anil  Medical  liotaiiy.  All  these  topics,  as  well  as  those 
:  :._•  to  the  i:  ore  din-etlv  practical  lirar.clies  of  medical  knowledge,  such  as  General 
I'atholo^y  and  Therapeutics,  Surgery,  Gynu^'olo^y,  Neurology.  Otology, 
Ophthalmology,  Ohstct  rirs,  i<iic-..  »v<-.,  iVc..  hive  'nc^n  assigned  to  writers  who  are 
e\|  •  :'-  .:.  t:.<  ;r  resjici'tive  departments. 

\V<  nl  cut  .llustrat  i  n  <  of  the  l>est  character  and  full-page,  lithographic  jihites  will  be  a 
!  •.  !•  1  feature  in  the  work,  and  will  be  introduced  whetvv.T  t  lie- authors  themselves  think 
•  hat  •  hey  ••••  .11  >erve  to  .  lucidate  th^  text.  Sji.-eial  pain.-  have  ]•«•(  n  taki  n  to  secure  as  large 
k  pro]  rt:  ti  of  or;  final  cuts  as  ;  issible,  and  nn  <j-]i>/i.<>  A-i.s1  ln'<n  njmrnl  in  <'//i'.<  or  in  ainj 
••'•r'.r'i-,  ',  ••  {',,•  »•.,.  ,'c',,  Kf,  -m-i  thf  hiyhist  <>rilr>- <<f  (fcillin<'f. 

d'Hi:  KKFKUKNVK  HANDISOOK  oF  'I'lII-;  MKDICAL  SCIKNCKS.  will  be  lim- 
ited '.in  K(  ries  of  Kight  plrmlid  Imprrial  Octavo  A"olum«-s. 

Th-^  ;•.%.:•.-  :,re  of  !:,r_-"  hi/e,  in  -loublo  column-;,  and  the  type  as  small  as  can  be  read 
comfortably  by  a  person  of  i.rdinary  _'ood  i-yeci^ht.  l^ach  page  carrying  as  many  words  as 
three  ill  octavo  pa_vs. 

It  will  he  •  .   -  the  volumes  admit  c>t  the  introduction  of  an  enormous  amount  of 

reading  matter    •  •.  .a!  to  the  contents  of  twenty  or  more  of  the  usual  ni/e  of    octavo  vol- 
iii!  •     .   which  ^;.l  bi-  of  t-o  [Taetirai  a  nature  that  the  entire  work  will  be  literally  a  hand- 

t k    for    r:;e    daily,   eonsrant  reference  of  the  Profes.-ion, — a  book  which  ><o  ],hy»ician. 

wiiD-e  t:::..'  i«  \\,  rth  any!    ing  at  a!l,  run  '/;?'</•//  '-,  '..    ,r.'h«ut. 

I,nr^'-  treatis'  -  on  th-   Practi'-e  of  Mtdiciiu.1  and  Surgery,  and  on  other  branches  of 
i!  knowledge    have  their  appropriate  and   n>  c<  .-sary   place, — for   long,  deliberate  and 
;  •'     :  '   -r  .  :          :        '..-1-  Ilefercnce   IIanilT>ook   i-  deMu'ned  to   furnish  not   only   Thor- 
ough  and  Kihaustlve  Information,  but  to  be  a  constant  daily  companion  and  ready 

on  all    branches  of  Medicine   arid   the   Collateral   Sciences. 
A  .arg-'  part  of  the  ::.;<.••  rial  co::ta;i:'d  in   tiiis   ii  A  N  i  >m  M  nc   is  original   work,  and    upon 
•    '-.   thi    information  now   to   i,..   presented   ha*  heretofore  been   inaccessible,  by 
f    .'s    bem.:    scat'-  r--d    t:.roi:g:i   ::ov.  r:!i:.enial  ami  other  manuscript  records  and 
.  •  - 

Prices  at  "d'in'ch  itu's  ~iirk  rcill  bo  sold: 

'    •    '-'  -'  i-b    •     .-  ;•;    ;  inding,  p.  r  volume,   8(1i."<i;    in    tin'.'    leather,  raisixl  l)an<Js,  per 

-'•'•'•    9~  in  i  -.-•'i  Turkey   morocco.   Knglish  eloth  sides,  per  volume,  $^.(X.». 

S^rirf  for  a   coinjiletf   (  ircular  r/irint/    lint    >,f  Contributors  (3OO~)  ttmi  Specimen 
j'U'jrs   from    tlf    Hurl.    frf,. 


AVOOD'S 


STANDARD  MEDICAL  A t'T 


L\  announcing  tlio  volumes  in  this  now  celebrated  scries,  ir 
may  -eem.  to  those  discerning  and  appreciative  p-nt  l.-ni«-n  who. 
from  the  lirst  have  availed  t  hem-elves  of  t  hi-  project,  unneces- 
sary to  repeat"  \vliat  we  have  said  at  diU'ei-ent  tinier  in  former 
yars  respecting  the  general  character  and  make-up  of  these 
book-.  And  yet,  as  many  thousands  have  entered  the  profes- 
sion since  then,  \ve  consider  it  nor  ami--  l>ri>'lly  to  rene\v  some 
of  i  lie  more  important  features  of  this  most  sncci-ssful  scheme 
to  snpplv  standard  medical  literature  at  lo\v  price-.  (  ntii  !>?'.) 
no  attempt  had  ever  been  made  by  medical  publisher-  |o  pro- 
diice  hooks  at  less  than  the  lar^'e  price-. .rendered  nece^-ar\'.  in- 
deed. 1>\-  the  limited  sale  attained  1  >v  most.  1 1  was  a  1  'old  vent- 
ure to  undertake  to  publish  twelve  volumes  in  one  year,  at  l»nt 
oiie-tpiai'ter  to  one-tenth  the  prices  previously  obtained  an  un- 
dertaking which  could  only  be  successful  from  a  sale  va-tly 
larger  than  ltef<  ire  at  tallied. 

That  it  was  a.  success.  andauTand  one.  is  certain  evidence 
of  ihe\vi<dom  of  the  plan,  and  of  the  sure  >uppori  wiiich  the 
proi'e--ioii  \vill  alwa\'s  accord  to  euierpri-e-,  conceived  and  car- 
ried  out  as  this  has  been. 

In  the  seven  year-  dunni:  which  ihis  liiti'aiy  ha-  neen  an- 
nually published, 

EIGHTY-FOUR    VOLUMES 

i)!'    mo-t    \alnabli-    nieilical    book-    have    been    i--iied.  at     \    •  O-T 
lot  he  I'e^nlai-  subscribers 

OF    ONE    HUNDRED  AND    FIVE    DOLLARS  ONLY  ; 

bllt      relU'e-ell!  ill"'     book-   la-     IMlbli-lled     ill     oilier    edilioll-      to     the 
I  i 

VALUE    OF   NEARLY   FIVE    HUNDRED    DOLLARS. 


Ii  would  be  impossible  for  any  publisher  to  issue  booKs 
of  [In-  hitrh  character  proposed,  at  such  a  noininal  ]»rice,  un- 
less  a  -ale  could  be  iruaranteed  for  the  series  very  much  larger 
than  is  ever  attained  by  bonk-  as  ordinarily  published.  We 
have  contracted  with  tr<  //-/•//<///•//  <iit(/t<>rx<  eiuiiieiit:  in  their 
>i lecial i i'-s,  for //<•//'  <in<l  <>ritj!n(t1  )r<>r/\x  upon  subjects  of  pres- 
ent interest  to  practitioners,  and  especially  conforming  to  the 
es-euiiallv  practical  character  For  which  we  desire  this  series  to 
!»•  known. 

If  the  t-xpenr-e  of  the  production  of  such  books  as  are  con- 
t cm pla ted  were  to  be  borne  by  the  sal^  of  an  ordinary  edition, 
i  he  individual  cost  of  such  volumes  would  be  from  x.").on  to  s7.no 
each,  and  in  several  instances  much  more.  l>y  combining  these 
volumes  into  sets  or  series  of  twelve  volumes  each-- -by  the 
closest  -crutiiiv  of  every  item  that  enters  into  their  cost  of 
production  and  sale-  -by  presenting  them  in  a,  form  so  attrac- 
tive that  they  \\-ill  enlist  the  interest  of  every  lover  of  books, 
and  by  the  adoption  of  a  system  of  distribution  by  which  every 
book-buying  physician  can  have  the  opportunity  <>F  examina- 
tion and  purchase,  we  are  enabled  to  supply  the  series  at  the 
uniform  price  of  sis. i  M  i  each,  except  MS  hereinafter  named. 

Seven  series,  have  been  published,  and  we  shall  soon  enter 
iip<>n  i  lie  publication  of  t he  eighth.  The  very  remarkable  suc- 
cess  that  has  attended  thi-  enterprise  From  its  inception,  the 
wide--  iivad  -upport  which  it  has  <'ont inih'd  to  receive,  has 
served  MS  a  constant  stimulant  to  Further  ell'ort  in  continuation 
iif  the  libraries  upon  the  >ame  hiu'h  standard  oF  excellence. 


IMM^SS    XOTICI^S. 

"The  pulilisheix  are  to  lie  thanked  For  their  untiring  en- 
•  •!_'v  aiid  x.eal.  in  \\\\\<  fiirni>hi  iiu'  the  jii-ofessioii  with  such  \~al- 
uable  pulilications  at  so  low  M  price— scarct'ly  a  nominal  con- 
-ideratii  'it." 

\\  e  know  ol    no  better  investment    than  a  subscription   to 
i  h —  >eries." 

I  I  link  o|  it  !   tweh'e  m-w  book<  ujioii  the  various  branches 
"'  in1'1    ''in'-  and  snrirery,  by  the  best  writers  of  to-dav.  for  onh' 
ii." 


"  I'm;  many  \  •  -:u>  past  M  l>-i:-.  WM.  \Vt  M  >|  >  ,\  <  <  >    ),.i. .  h.vl  ';:id'  r  r.  •!.-!    .---iti  •  !.  :W 

f.-a-il.iii'y  ,,!'  pmdn.'in.:  iii.-di.-a',   I k-  by  f,,r,  i_-!i  a:;  1   Am-  •  :  M-.  V/!.    i  i  -:  -.'.-, 

and  y,  !    ;it   |,:  ;,-.->  L'M-atly   l'-s.-    tlian   II.T.-I.  it'.  >]•<•  at  t.  in  | .:  •    l        Th.     i..    i.      ..-•   ..;  •:.   .,:.-! 

i>:'  u'.l     tin-    mat. -rials   u-i-il     ill    til''   Iiiailllf:ti-lur>-    ».     I k-.    h.i-    i  •••••    i      ili    in-'.i  •  t  ;i't  .• 

st.ii'!"'       K\.-n  im\v  it  \\<iiild  In-   inip..."ihl''  tn  rarry  <>u'  -_•-!•  in. I'...M". -.   :i:n-  •  i- .t   :: 

tii.-  nrdiiiarv  m.-th  ids  i'f  trad"  w.-rr  .|. p.  nd"d   up"!i. 

••  I;   i>  In-lit- Vi-il  tli:it  tin-  .Mrdi.-al  I'mlVi-Mnii  u  i.l  \M-l.-niu--  :i!i  i  -•  :.••!••!:-'•.      ij-tjtt.1     :itiv 

:,-/,.>  ,n\'it  of  such  chara. 't.-r.  :iu<l   i-oii.-.-.ni.-iitlv   tin-    f..i;..-.v  in.  -,-li.  m-  l.a-    • 
p!''-]i.i:  -  '1  \\ith  much  cart1,  and  is  !•<•> ]"•'•! I'ully  Hil>mit!'-<l  !ur  th.  ii •  :ipj>i  <>v;i.  :.:.  1  -:,p|..irt. 

••Tin-  I  ii  inks  M-li-i- 1>  -i  1  fur  jiuliliriitiiiu  in  this  >••!  i.->  will  In-  i-lianu-tfi-i /.•••!  l-v  '!:•• 
''  '•"'  ii.it  in1"-   nl'tli'-ir   cuntciits --.~o  far  as    |«',-~il,l,-      ra!  li-i1  than  ////.//•//.       !:•    ^.  !.•:.;      -In- 
n.'.\.-[     :ni.l     must     rrn-ntly     \vritti-u     \vurk-.  only    wii!    In-    iucliiili1"!  :    ncc;i<in!i;i'.!_\ 
-t.iii'ia: '1  hunk,   lint   i'i';t'li!\'  nlitainaMi-   <T  mi'  ni'   j.rint,   \viil   !"•  r«-jir<>diii'«-"l.       !!•  ' •  ••  :."••• 
:  •  l!,i-  :it'i-.-  <>{  !m..k~  Ii.  i.-in  ;tiiii(iiiin-i-.l   will  rl.-ai'iy  >ln>\\   tin-    inti-M  d'  th'-    jmi -li-  ;.•  -r~. 
;t'.!'l  thi1  \viili-  raiiL.'"-  of  >nl>Ii-cts  inchi'ii-'l. 

"  In  tin-  iiiaiiin'acturi-  of  thrsi'  Imnks  thi-r--  i-  iinthi:i_'  ""initt.-d  "--.-nti:ii  tn  Vr-'  '-..i~.-i 
wni'k  :  tlu'v  ai'i-  as  \vi-ll  nui1!'1  in  i-vi-r\  ]>ar:  ii-'iiar  a-  th>-  hi.-li  jiiii-i^i  i-ilitinii^. 

"  A  liroaii-t'aci-d  I.oiii:  I'rimcf  tv|n-  i.-  n-i-.l,  ra-t  i  — jM-rial!  v  fur  tlu->>-  V"'.;nn---.  :n:-l 
v.  itli  thi>  'yjii-.  and  si/i-  of  jia^'i1  adn|it"-d.  tin-si-  vnluni'  -  wiii  ruiitain  a-  ni'i.-h  in  rt.-r 
;i.~  i-  fr-'ijiii-utlv  ini-liid«-d  in  an  nrdinarv  t'^nk  u!'  ."idli  tn  ^Ull  pa.'-s  'I'll'-  paj" -r  i-  !'.iii- 
I'l'i-ani  laid,  inanul'actnrrd  i-\]iivssly  fnr  tin-  piii-pn-i-. 

FINE     COLORED     PLATES    AND    SUPERIOR    LITHOGRAPHS 

\viil   In-  inti'ndiii'i-d.  and   \viiiiil-i-iii:raviiij.-  will    I..-  t'ri'i-Iy   i;.-cd  as    i-.-ipiii'.-d.  'I'h-    r^v.-rs 

a!'"   ••;'   ti,.-    in-~t     hard    l-i!idi-i>    Ima'-d.   mvi-r.-  1   '.vitl:    a!i    '-xtra    i|ii:iiitv  and  i-n'.":1   n!    :TII- 

pni't.-d   in  1 1.-!  ill,   and  '-in  I  »  -.-i-'  1  nn   ill'-   l.a.-k  and  sid'-s  \\  ith   lii'\v  and  nri_'ina!  -lamp-.       In 
(•Vi-rv  M-HM-   thi-v   \vill   '"•   hniir>tiv  lirid.-  Imnks.'' 


'I'hi'  al'iu-i-  .'Xpri'sscs  tip-  purpos'1  nf  tin-  iiiil'li.-li-jr.-      a-  aniiniiin-i-d  in  liii-ir 
ti;.-      at  ti.'1  iipi'iiiirj  o!'  thi-  rnti-rpriM'. 

I-?;  •     Tlnlt      I',,       1-iKilU    /HI*     lll'li-/,     ,,!"!'<     //nil,     ,in  t     //,,      ,,1-,  ,,-,',///,,„     ,,;'    ,V.v     ,„,,„! 


IMlio  ;IIM!    l'«n-<l"«.     "  1  lln»l  i-jil  ioiio   <>("  l>i«.»i-<-i  ion-." 

^1  ii  11  «!«•"*     ••  4.  >  u  <•<•<>  I  o;i  >  ." 

ll:ir(    ;in<l    IC:i  rliou  r*»      ••  l>i-«-:i  •-<•-.   <>T  \\  <•  m  i  n  .  " 

<   :i  !-|»«-n  I«-r"x      ••  TI  MTOXC-OIM-    :in«l    i  I  -    II  <   ^  <•  1  :  i  I  i  <>  11  -.  " 

l*:ii-l»"««      ••  II  >  a  i«'iu-.*"    •%>!!!!    il*    "    i  in  .  i-i  <  ;i  n     \  |>  |><  11  (I  i  \  . 

l».i;-|»"-.      **  Itiocil^fo    ;IIM|    Irijuri.-    ol'llic    llor-.-." 

lloi«l<-n"».      *•  II  11111:111    O-l  «-olo;i  >  ."' 

.1  oh  ii  oon'o      "  tl<-<li«';il    |{ol;iii>." 

^<>\«-«."      "  l^i«,«-;i  •.<•<«    ol'IlK1    !'.>«•." 

It  i  ?•;»<•«."      "•  I'll  >  »iol<>^;  >  .""   ;in<l     *«-r\    in;iii>    o||i«-i-*. 

••  :'  h   :i       'Ji-ir  \\  .-a'r  Ii  n.''  i  !  !n.-tral  in!.-    i;i    •  ••:,:.';•' 

•  \"IT   l'"'i-lll'rin.     inatti  r    ''!'    ..  I'a'  ::,'-;'''•',    '"    ':.  •  '  -.     .' 

-•:!p'!-.    rvn  tn  1  .....  kmak-rs    a!    th.-    I'a1';'.:'  :•  -    f    I;}"-  :!.- 

in    la  .  .   :i^  d  "'..-!'  >i"<  1   1  1\    1  1..-    pul'MHi.-r-  "!'!  h  ".-.•!•'  tin  •  \.  i  '    •  ,  -  -. 

i  I  )>  tai!"-d    iiil'ni'liia:  inn    i"    ardin  .    '1    •   '.'"'   ;IM-  -  p1;' 

fnlllld     l[pn!l      th"    t'i.l!i)\vill.     pa_'«-s.     tn     will'- 

invit.'d  iip.in  th"  part  nf  tin-  •••//••j'"'' 


IBRARY  OF  STANDARD  MEDICAL  AIT 


T    ;>    i>  i-iTtainlv  ;i  i 

]..  .'"I     t'l'i  '111    '  hr    pl'i  ifrssidll.  " 

'i    .    df  tin-  n':t~nTi<  \vhy  uinliral   In  mks  arc   so  expensive,  as  compari'il  with  liooks 
•.  •    •  .•      •     -.-  their  rdinparat  ivrly  limitril  sale." 

i  »j  ihi     "i!v\\a\    in  whic-li    On1   ciitfr]>ri-i'    <-;\\\    pav   its   nri^iiuiturs    i--    in    an 

;    •    .  :.   .         :  .-i-ripuc  'ii  \'-^\ .  ;ti.i  i  \\  <•  cai'm  >l  I  v  a>k  Sir  a  '..-c-iicral  snpi »'''!   ale  'inr  mir  line.  " 
r     li.nk  fi«r  thi'  -ii]i|icirt  of  tin-  prufi  --inn  in  ;'iis  rnicrpvist'. " 

Ili-llii  •  111-    pi''  ifi-s-iiiill    -hnlllll    l-Tl.li  •] •-• 

y  tn  piui-iin-  in-\'.    1 k>  at 

.  :        n--. " 

•  M  \...  ;ni«  -  will    IK-    ilbist  rat'-il.       Nnlhiirj'  yl    nil'crcil    \vili   at    all   cdin- 
p:t!          liit!  I  inn. " 

\     •     '      •       .          •                       i-j.t .  wi-  lidjic  ii  .         liirii-iitly   n-niunt-rat  iv  •  to 

'I'l  '     ii  !•;: .-  ari-  -'i  fi-a-i  nialili-  that  a  library 
.  •    •                                                                     '  •    •  •  -r  •':,  nf  all.  " 

•  .\       ;               •     i     licvi'    ;h;il    cvci'v  innlical  man  in   ihc    pi'iifosinn   shonld   rntrr  iiis 


ill,     nhori     I'riss    \<tfiiT*  s/intr  lh<     ir<lcnni<-   ifii'fii   fo  IIic 

nt    i/s    t  nri'jtf  ion  . 


1    •  •  '  firi'i    ilii'   arti^lic  wnrk.  i-sprrially.  it    is 

ir  '  '•::       •  >!'   mcilii-al  pnlilicat  inii-, " 

-  •  .    ,i>n«  -s  i'f   tin-  pnMic-atidi)  i-i-rnni- 
lii     iit-i 

k-   I'.'lll    In  nr    t  111'     IHOIH'V,        Til'-    '.''-t-llp 

:'    .  •    •    •  •  prirctl  filitiuus  now  Ix.-iiiy  sold.'1 


IBRARY  OF  STANDARD  MEDICAL  AIT 


1005. 

Seventh   Serie*.     Price,  *      .       .     Volume*  not  sold 

HUMAN  OSTEOLOGY.     r,,nipri«in^  n  I>e-cription  of  the  I5..n.-,  -• 

nf  1  he   Mll-ele-.    till-  I  ienerill   JUKI    .MliT..-c..p|e     Mnicll.rr  "I      ll'Hic    ill.'l      ll-     '.'••. 


KIRKES'  HANDBOOK  OF  PHYSIOLOGY.      I'.;.  \V.  M'  >;;  |;  \NT  Ii  A  K  Kit,  IM; 


work,  t,f  it^  kin.),  ;in.|  in  this  i.r\v  r.liti..n."  |:;-r  .-..nip  .  •!••  •!   .•>    IT-.   I'.Ak.-r  iih.l  II  n:  .-.   .-    pi  .    ,i;..j.  .,-  :;• 
<vpt:»l>!<'  ;i  li.mk  mi  [he  r.  ill  >|'-ct  ii-  ci.uM  lie  pr--M'Hii-(|  ;.i  i:..    pr.i.  ;:!;••:,•:•-  .  .1    \:i..  :  :•  .  i. 

THE  SAME.      V.  .lain..  II.     \Viili  m-arly  x.'.">il  iiltistmtionv. 

ON     THE     WASTING    DISEASES    OF    INFANTS    AND    CHILDREN.     !'..   l.r  >  r  \(  T  -M  i  i  H. 
M.H..   I..  .:.•!..   /•'.••;•..'/•  "ft!,-     i;."/:i!  <'"ll-  '/f  "f  /'.',,/,  ,t/./.,-  .-   /"..,.,.•..,  ,'.,'/,,    I/    :.    •",,/'.      A,     ..,./('.    /,. 

»//.(..>     /'',-..,,.(.(-/  '-  .",..  A'./v'   r.<»ni-i,   i  i,  ;:<[,:  .,•,//.../,.,'.(/  ./,i,/  r..  ,-/.    <.'./•.'/.  .....  /..//..> 

//,..,,,.,,,///,,    (7,,..^,    l  •/'•/.  .,•/,(  /'<//'/-.      I'.,  nnh  Ivliiii.n. 

!:*   ..i  Mi-li-'in,..  i'-  Uy  ilu-:ii-.-,,iii].!i-,lu-.l  iiulhi.rt.l    ••  I  'i-i-a-i-  it,    i  'i..:  .r.'i.."    ..,.;.:.;.    t  -.1..^-:  . 
A  TREATISE   ON   CHOLERA.      l-Mlfd  :ui.|  pt-.-p:uv,|  l.y  I'liMi'Mt  ' 

' 


Catalogue  of  the  Titles  of  the  Works  published  in 

IVonirs  LIBRARY  OF  STANDARD  llnrAL  AITHIIRS. 


Sixth  >cn«-».     l'ri<-<-.  •».!*«. <>o.     Volumes  not  told  separately. 


LEGAL    MEDICINE.     r,\    CHAKI.F.S    ME\  MOTT   TIHV.   M.I).,  V.C.K..  Mister  of  Snrrjtry,  Proffer 

•  •'  r-Kunntra  ,«•/•/  <>f  /•'"rr/w  .V.-./i  -ine  and  /'italic  ll,"Mh  at  the  l.n,,,l<»i  Jloai>itnl,  MeUicdl   (\<Jli:<r  of 

,'f    i  •'•  ',.-•  A.V:i  ;.''•!,  T.t'.''  !>  ii-''"  Mt'l'fitl  O'H-er  t>f  Health  <i"d  I'tl'iUn  Analys:  fo>- ttt,- L'Uy  uf  Landon, 

•.;:.      C    '.•>•'.'.•-:    I,"L'itimncy   1111  t    Paternitjr— Prcfrnain'v,  . \bnrlion— R-ipi-.  Imlcoi-nt   K\- 

,  •;•• <  hi  iiny.  Ur-n.ility  — I.ivi-   Birth,  Infanticidi — Asphyxia,    Dn..vniiiK — II:ingin;_r,   Klr^uij-'uhiti.in  — 

l'ATHOLO'3-Y    AND    TREATMENT    OF    GONO3RHCE  \.       I!y   .1.    T..    MIT.TOX,   M.D.,   JI.R.C.S.. 

,  7-  ,,t<   [i  .    ixni  «f  the  Skin.  St.  ,Jnhn'n  llonpitnl  <\,r  M  in  /•...'(/.•>f,s.  ftr. 
'  •  •"  ["hi-  w    ik  i"  fri  .-,!',   from  the  author's  hamls,  ami   treats  in  a  very   )>r:iet:eal  way  of  this  (:onini"n 


A   PRACTICAL  MANUAL  OF  OBSTETRICS,     fiv  K.  VKIIR1  H!i.  M.I).     Tninslateil  from  tlie  French. 
..    I.    P  \  UTiM  in: !'..  M.I).     I'rofusolv  iUustratiHl  u-ith  tine  wonil  fiiuravin^s. 


::  .-  !  IIYSICIAN'S  VADE  MEC'JM  :   .V  Manual -if  the  I'rim-ipVs  ;ui.l  Pr.u-tir,.  of   Phys-ii- :   vith 
.fi!    !!•!-.:   I'.itho'o.'v.  Th -raueutie-ivml    IIy(.'i"n<\     'JVnllll-Mitii.il.      Kevi<i-il    by    WILLIAM 
"V.   M.  »..  Cantali,   I'. U.S..  .1  )HN    H\KI.!:V.  M.H..   l.oml.,  L  L.S.      Vuhiuu:  ]  I.       Jllus- 
.      :.  •:  a1,  int,'^'. 


DISEASE: s    r  THE  -ESOPHAG'JS.  NOSE  AND  NASO-PHARYNX.   u\-  M' 'i;i;i:i.r,  MACKKN/.I i\ 

"      i.,    :.             .       -:  /'/,      .      (./    .-•••/,.     II 'iiitu:   f.n-   tit,     lii*e>ixcx  nf  tlv  1'lu'nt  Hud    Tin-fit,  l.-.lnrt-.r 

'.'    •  i        ••'  '\-    :'  ••     "    :     :   ',,1, n  ff,t.iiiittl  M-ti'-.t    <•>:'••/•>.   >'.;>•.      louslrated  In  \vo, nU'n-ravin.i:-. 

J  "-"^"  .'  .              k.  n  iim-ly.   "  Di-ea-e-i  i)f   i  !u-  l'liav\  nx.  Larynx  ami  Ti-.-u-hea," 

'i    :    ii-  I.     •-.   n.!   1— •',  a:i  1   elieued   thf  warim--t  coiiiiii-niiation    from  tin- im:.lii:al   jiri'-s 

A  TEXT-BOOK    ^F    GENERAL    PATHOLOGICAL    ANATOMY    AND    PATHOGENESIS.     T.y 
•i  •..'•   l>'ith»;.'i     ill    Annl;m'j   i"    »<•    t'iiir,r»ity   -/  '/':<'„  n</», .      TrHii^laii-I 
h    >N\I.I)    MACAMSTl-IK.  A.M..  M.U..  .»/•!«'«•/•</«<•  7.V/'i< '''(//ri/' 
/•i..-    /'•       i/-    /  (./    >/• .(  •   <•!.,_•• '•!/•'>•  a/  M.  -/H/IH'I  <  :<>llru>,  Crinibriitge. 

-.   "i..!.-   I    VI  II.      I'njfu-i-lv  illii>trati-.l. 


IBRARY  OF  STAMIAUD  .\lnr.\L  IITIII.IRJS 


I'i  IHIi  Serif*.      l»riff,  *I*.OO.      \  oliiini  •.  noi  »ol«l  •«  i»ar:tl  4  I)  . 

MANUAL  OF  GYNECOLOGY.  liy  D.  Itr.N.I.  IIAKT.  M,l>..  l-Ml.r.  I',  i;..  l.,.:urcr  ..«  Wliii/,ry 
'i  1  />I.V.|A-I  "f  \\',nn-  it,  N.7,,,,,;  ../  M,,l:.  i  ,,'.  K.li>,r,,tr-Jf,,  <t'\,  <•[•'.;  ;n..l  A  II.  !:Ai;i:'  i!']:.  M.A..  I:  -.-., 
M.l:..  -\-.int'i'it  tn  th>  />r<>/-'xi<>r  ••/  M<-t"-'/'i->/.  t'nir,  r*ity  »f  K'ltnhtu-jfi.  V.>him.'  !.  i:  u-'rut-l  -.nt!i 

MANUAL     OF    GYNECOLOGY.      r,>.    1>.   r.KN.I.    HAItT.   MI'.,    K.l:.(  M'.K.,    /.•••.'<.•/.  r  .-,    M   i-, 

•  i  ,,l   /</,•  M.;V  ../   ll'.'/».   i,    .->  ,'<j.,;  ,/  .I/-  (.-•,•„•,    /:,!,  ,','ir  /><.   •  :•  .   el--.:   ;n.  1    \.  !I.   i!  \  !;!>•  >  '  '  i:.   M.  \   .  !;. 

<,-..   \\.\\..  Aasittunt  to  t>,-    I'l-ofi-wr  <>.f   Uft'nf.  n/.   I    nr'f.,t>/  of  t:>U:i>ntt  -<jh.      Volume    II.      I  '..:-•:  i'.,i 

\\.l:i  ;i  ht!i.>.-niT.)ii.'  [  :  n.-  .iii.I   -JH'.I  tin,'  -.\  .....  1  .  n-r.r.  in^. 
THE    DISEASES   OF   WOMEN.     .V  M:nn:.i;    i'..r  1':.;.  -'.•:;•.:.  •   un-l  Stmli-nt-i.      I'.y  1  1  1'.i  N  ILh.'H    n:lI.-'H 

M.I).,    /•;••/'.'«"/•  r/  '/i,'/!-   -.'•.'/'/  -I  "'    H^l.tri-'-i-ie   ."..'    C'<i>:r-i>i/  <•/  //-J.V.      Tr;vn-::i:«\l    !.y    ISIli'iUK 

ITIIST.      I  ::•.;-•  nit.  M  wli'i   ;.Vi  lin.-  \v  .....  i  .-nirniviiiL'-. 
THE     MICROSCOPE    AND    ITS    REVELATIONS       !:,    >.VM.    i:.   i  '  \  IUT.NTr.lt.    C.H..    M.I).,    1.  1..!'. 


THE    MICROSCOPE    AND    ITS    REVELATIONS.      l;_v   \','M.    K.   CAiilT.NTKK.   C.I'...   M.D.LI..D. 

s''j--;-  l-:,l,H"ii.     V  iliiJiif  1  1.     H'.ii-!tr:ii'-.l  with  •.'';  p'.:it.-  nn.i  ,">ir.'  lin.-  w..o  !  i-iu'r:iv:i.t->. 
HANDBOOK  OF   ELECTROTHERAPEUTICS.     I'.y  nil.  \VII.IIKI.M  r.Itl'..  /V.//C 

.,•/</  ../'  /..-<;.  :/!/.       r.!i:<tr:i:.-il  1>\  -'.'.I  w.  ...1  ,  !:_-ru\  hiu'- 
A    TEXTBOOK    OF    GENERAL    PATHOLOGICAL    ANATOMY    AND    PATHO.iENESIS.      r.y 


;i.,.l  !-,l!r,  -,|  f..r  Kn^i-h  -in  :ci.]>  i.y  DOS  \  I.   Mf.U.ISTKIt,  A.M.,   M.I:..   M-  ,,,','r  >-J~  t!,.    A'.^.!.' 

THE  TREATMENT  OF  WOUNDS.  IVin-  a  T.v;1;>,-  ,,u  ilu-  ].rinci|.!.'s  ::p,.n  which  :!..•  Tn;itn.,  i.t  - 
\V..;;n.l-  -!..,;.!  1  !..•  f.  iiu.l.-,!.  ;in  i  ..:,  ::,.•  l,,-.-t  in.-h-  N  -f  c..r:;.  n._-  I!:,-MI  int..  pv.icti.'c.  inc'.u  V:..-  .  ,-..n 
-iilcnit:..!!  iT  1)1.'  ino.l!:'c;itii.ii>  which  special  injuries  mny  ilcm:uul  I'.y  LH\VI.-  S.  1'lIX'll  KK,  A  M. 
M.I).,  of  I'.rooiviyn.  N.  V.  i;!i;str;r.i-.l  liy  woc.l  ci.^rn\  n.-s. 

A    MANUAL    OF    PRACTICAL    HYGIENE.      I'.y    KI  >.M  r  N  I  >   A.    !'\UKKS,    M.li.,    K.U.S..    /'.-•     /'/•- 

«,-.-,'     (•/     I/.     '••"•-/     //."/-/''•     '•       I"      "it      .\r-ll!l      M:,i:>:ll     .-      -...I..-.        M.   Hi'-,      .'f     '!••        ',:      ,  /       '.'        ' 

f-/,/c  /'  -'•  :   /•'•    '.'•"•  >>f  i!"   .<•'»-/',-  ,,f  it,,-  /••">•,,,,•>/  ../  /..//-  /.!.•<;    A'/.i.  /-'-'<  /•/.'•  —  •/•  ,•_•-  i  •;,  ,.    :    M,  ! 
•  ;,:    i.;    I  „>>•,,  *,•>,'   ''.'//.;/..    /...//.f"H.       Mli-.i-l    i.y    I'.    S.    I'lIANTiilri     1  ii  i  '  1  1  A  I  '  \I  .  'N  T.    V.    I'.    i'.i.S 


i.f  >;r--it   i:,-:-<ii>:    /'/•••/•;<  w/1   •'/   M:^I  u-;/    II-  i,e  >••   ,i    i'.,-  \rnxt    M-  i    u 

V..1H-:..-    I. 

MANUAL     OF     PRACTICAL     HYGIENE.    Vv'ITH    AN  APPEr.'Di:-:. 

•  i.  VIA'.  '•.•..'.(,/-.-  1      ••,,;/•:.;  H-,..,-.      hl'i^n:.    .  !.,  el:-.,:-.,  i;  l.o.-i-ivhic  ;,;, 


;  <•'*"  \  •      •:   i,     :.  •  ..•!!    -ii    \i;.>  i-;.  MII   i'.ii:'.,:i   ..f    H,  i  ,;.   -  w.- 

i;>    :  •'  i  !••  S.-  :.-..'-  :i-.a:  thi~  !••••!  ,..,i  ..f  ;ui!...:'it  imi  wi  I    ,•!',.•  !..  :•;   :.f  ..-.: 
:in  i  Tn...Vn.-i:-  ..!'  li;f..iili;i'  -y|.!i.l:--  IM-II.T  thiin  .1  c..,:;.|  t..-i-...    :..:.     .Mini    : 
A    TUEATISE    ON     VETERINARY    MEDICINE,    •. 

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IBRARY  OF  STAND ARD MEDICAL  AUTHORS. 

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ILLUSTRATIONS   OF    DISSECTIONS.     In  a  serie- of  original  colored  plfttrs  representing  the  dissec-  « 

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LECTURES  ON   DISEASES  OF  CHILDREN.     A  Hnml-honk  for  Vhycipinns  nn.l  Stu.leiits.      liv   Dr.  i 

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MATERIA    MEDICA     AND     THERAPEUTICS.       In-r^.Tiiic    Piil.stnnees.      T,y    CHAIJI.I:.-     li.    !•'.  % 
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PRA   T;CAL    MEDICAL    ANATOMY.     A  ^uide  t.>  the  physieian   iii   the  Study  of  the  Relations  of  (lie  S? 

V;-e.-ra  t     ..'•:.  ot  h^r  in  He..  ith  and  Disease,  and  in  I  lie  l)i»L'iio-is  ..f  the-  Medieal  and  Suix'ienl  Condiiion.-  »-2 

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ON  ASTHMA:    ITS    PATHOLOGY    AND   TREATMENT.      !!y   III'.MIV   lIVDi:  SAT.TOU.   M.I),  *, 

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Catalogue  of  the  Till«>s  of  \Vorks  published  in 

11'iniirs  LIIIIIAHV  OF  STAMUIIH  .\li'inr.\L  .liTimiis. 

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MATERIA   MEDICA   AND  THERAPEUTICS  OF  THE  SKIN.     i:-.   lii:.Ni:V 

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Catalogue  of  the  Titles  of  the  Works  published  in 

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VENEREAL  DISEASES.     I'.y  P..  I.    K  I'.YKS.  A.M..  M  I).,  A^tunet  TrnffMnr  of  Surgery,  and  frofexKnr  ~ 

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A  HANDBOOK  OF   PHYSICAL  DIAGNOSIS:  Compri-inn  the  Throat.   Thorax,   and  Alidomi  n.     ];>•  g 

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A    TREATISE    ON    COMMON    FORMS    OF    FUNCTIONAL    NERVOUS    DISEASES.     Uy    P.  X^ 

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THE    SURGERY     SURGICAL    PATHOLOGY    AND    SURGICAL    ANATOMY    OF    THE    FE-  -  i, 

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•  •        r    "  ..!    the  A.lvaia  .,1    Snalenl   ai^l 
:  .-.:,'"   P::.-ir:.i  •  i.  -. 


Catalogue  of  the  Titles  of  Works  published  in 

IVoiiirs  LiBii.iiiY  OF  SmiuiiD  .\kinr.\L  .\IT 


rir«»t  Si-ru-o.     I'rirc,  *»I*.<>O.    Volume*  not  «.<>l«l  M-|mri:U'l) . 


DISEASES  OF  THE    INTESTINES   AND    PERITONEUM.     (.•..tiii.n-iisK  Arti<-U-  .m  — i:nt.  nili/ia 
l.y    .MllN    Uini.Ulli    NVAKHKI.I..    M   I)   :     Ki.trri'i-,   ( >l -:r:;rii..n    -f    li>-    K..\u-.-.    U ..-.-r  v .••;.    ..f    II.. 

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i.:.i:..i-  :i:..i    \-.- •!!•-.  '.y  .KHIN    .-VKK    I'.HISTu'.VK.  M.H. 


MATERIA     MEDICA     AND    THERAPEUTICS          V,..TI:I  ,'„>     K  !.._•  i- '-.         l!y     C!lAl:l.I>     I'.    1' 

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1'.  F    Ml'NUK-lI.  <;.  PIFF.M!!)— U.  A.   \\T1TI  I A  I'S— II.   M.   LYMAX— M.    KOSFXTI1AL-- 

F.  T.  FKI:I;II  us— \v.  i:i;u—  K.  r..  PAI;TKIIH;H-A.  TK^I  SSKAI'-J.  M.  CIIAU 
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Ziemssen's  Cyclopaedia  of  tn«  Practice  of  Medicine, 

•i  T.-.c-.ty  Royal  d/J  Vols.,  incluj.ng    BUCK'-.  H,  &:<•"•_•  '2  <-'•-••!,  a-  vi   t.-.e  Ge-icrd.  Ir.ye*. 
WITH  WHICH   SKT   IS   I'lir.sKXTKI)  A  CoJ'Y   "I' 

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maintain  its  place  as  the  j^reat  storehouse  of  medical  knowledge. 

It  seems  proper  upon  the  conclusion  of  this  ^reat  work  to  a-k  attention  to  a 
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Wood  A;  Co.  \vas  first  directed  to  the  advertisement  of  the  (ierman  publisher,  in 
the  earlv  part  of  1<S7;$.  After  consultation  \\itli  a  number  of  prominent  gentle- 
men <>f  tlie  profession,  tliev  concluded  to  venture  upon  the  translation  ;md  pub- 
lication in  English  of  the  work  to  which  it  referred,  the  largest  undertakinLr.  by 
far.  both  as  to  the  editorial  labor  ;md  the  amount  if  money  involved,  of  any 
medical  publication  in  the  English  lamj'ua^e. 

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ers could  sell  them.  were  based  wholly  upon  the  ]iublished  plans  of  Mr.  \  •  "j'el  - 
thus,  whili.-  the  '•  copv  "  came  from  (lermanv  \\ith  most  sat istaet<>!'\  r(-!_rulanty, 
it  was  soo'a  found  tiiat  the  volumes -\vould  much  exceed  the  estimated  number 
of  pTj'es;  and.  after  several  years  of  publishing  1  ii';jely  increased  volumes,  it  vsas 
found  that,  even  with  such  addition,  i'  would  be  impossible  to  complete  the  work 
in  the  fifteen  volumes,  as  at  first  announced.  The  alternative  then  pn  s<  nted 
was.  to  increase  the  number  of  volumes,  or  abridge  th"  matti  r  ;  tlie  laid  r  cour-e 
would  have  lieen  Jnudi  pr(-ferred  bv  the  publishers,  as  enabiiiie-  them  to  ndht  re 
strictly  to  their  original  est  i  mates.  So  maiiv  inlluential  subscribers  objected.  In  >w- 
ever.  that  th<-y  felt  compelleil  to  announce  that  two  vulumes  would  be  added  to 
the  set.  It  was  hardlv  to  be  expected  that  there  -would  be  absolutelv  m>  adverse 
criticism  of  this  course  anion^'  so  lai'-j'e  a  const  it  uenc\-  as  the  subscriber^  to  this 
work.  It  has  been  very  ij'ratifvinir,  howevej-.  to  find  that  this  change,  wholly  be- 
yond their  cuiitrol,  has  been  unsatisfactory  to  le-sthan  one  per  cent,  of  the  sub- 
scribers. To  show  the  difference  between  what  thev  promised  and  \\hai  has  nc- 
tuallv  been  j_nven  subscribers  to  Xiemssen's  Cyclop;edia.  the  publishers  LJIVC 
lu-rewith  tlie  number  of  pa^'es  of  each  volume,  in  coinparisnn  \\ith  the  average 
numljL-r  as  at  first  estimated.  \  i/.  : 

Promised,  per  volume.  .~)iio  to  TIMI  pa^-es.         Average  of  t'>»H). 

Vol..    1  7l.M  pa'jes.         Vol..   7       l.Hfyd  pae-rs.         \'oi..  \'.*>   -      '.i.sT    pa-^es, 

•1    -    7i;:>     ••  ••     .s        '.M'.'  14        '.M  1 


••     c,     l.n:;s     ••  ••   !•_>       \\\  i     •• 

Total  number  of  pa^vs  <///v.;,///  /viv/c.v/  by  Sub-cribi  r. 
'/.-•  /••/'"in  !.-•'•'/  b\"   Publishers, 

Given  to  Subscribers  :ihove  their  expert ations.    • 

(:/•     I  III'      I''!'/  Ll''li'!!'l  ''    7    '.        l-lllllllll'*        I't'l'rulll       1)1111        /M        7'M)         I  II /,/>'.<        I'    fit. 

now  to  be  add"  1  -till  a  not  he  r  extra  volume —  Diseases  of  tlie  Skin. 

It   is.  of  course,   well    known    that   though    this    extra  matter  has  cost  the  sub- 
scribers nothing,  it    entailed   a   very    heavy  and    unlooked-for    expense    upon    the 

publishers.  'I' hey  believe.  In  >we\  er.  this  endeavor  t  i  do  I  list  1  v  and  </'',,,/-.  ":*/'/  by 
those  who  had  supported  this  e/reat  undei'takin^  iris  b«  e:i  ajipreciated  by  them. 
li  ',-  with  no  little  satisfaction  that  the  publishers  can  look  back  to  the  un«  \- 
ampled  reM-ulanty,  in  book-publishiiiL;',  \\ith  uhich  the  \olunie-  appeared  e\  >  ry 
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tin-  work.  WM.  WOOD  ic  CO.,  Publishers. 

V  i 


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-:•,:•.  •'  lit  I  I'M.'  .•!;<•  iin.l   Public  11,  'alth.      T:irl->. 

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/  •  '.'       EN'S    HANDBOOK   OF  THE    DISEASES  OF  THE   SKIN 
DY'S   SUPPLEMENT  TO  ZIEMSSEISTS  CYCLOP/£DIA. 


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L'NITKD   Sl'AI'KS    I'HAKMACi  i    '(Kl\      Ai.  ••  li.-.-;i-  i.--'  ..i;.i  M.-I  n.'  S  ,  >n-iu  , 

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TIU:  riN I:-T  AI;I:  \v ,i  MKNT  vi: :  n   • 

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SKND     i     )K     IU.USTRATK1)     ANNOUNCEMENT 


INDEX. 


ALLEN.  P.     Lorturrs  on  Aurnl  Catarrh  ...... 

ANATOMICAL  REMEMBRANCER  ....... 

ASHBY.   H.     M.'munimla  nf  I'tiy.siiiltiK.v..  ..... 

ASHHURST,    J.     Tin-    lnt.-rii:iti(.n:il     Knoyr;,, 

BARTHOLOW.   R.     Sp.:nniil.>rrhn-a.  .  . 
HARWELL.   R.     A  TtviUiM-  on  J)is.-ivs<->  ol   the 


BAITER.  L       l.rctun-xoii  i  inhopaMic  Sundry. 
BEARL).   J.   M.      Ni'i'voi-.s    KxhauMioii.  N.  :.:•;.- 


COMSTOCK    and   COMINGS.     I'r 

CORSON.  j'.'W.    "',,.  A..,   T. ,..,•:•. .-M  •  f 
COULSON,  W.  J.      is::i.l  :.  •    . 
CURTIS.     E.       M.-ui-.i.i. 

T.  .-'.•..•:•  •_•• 

UELAFIELU.   F. 

.11. .MA,    Vi.l.    I      .il.. I    !  1 

DELAFIELD' and  PRUDDEN.      I':i 


BENNETT.  J,   H.     ('  .incul     I..-.-M 

I',  in.  ip..-  mi. I  I'nirti.-c  of  M. 

BIJELOW.   J.  '   N..f;r.    in  [Ms.-:1-r 

iniKil  M. '.l 

B!NZ,    C.      Tni 

BLYl'H.   A.   W.      •(•'•..    Au:iiv-i- ..f   F I  an,l  i 

It.-', 

BOCK.   C     E.      A:  n-    •  I     lli::.,:in    Anal 


ELLIS  ;.nd  FORD. 

ELLIS.  E.     I'.-.- 

EMMET,  T.  A.  \ 
EHB.  W.  I  ..:!-.  I 
EKICHSEN.  J.  E. 
FLINT.  A.  r  -:; 


HOOFER 


FHYSICIAN's.      /A  HE      ME 


f,4        ITBLICATIONS  or  UILLIAM  \Yoon  \-  COMPANY. 

Jn<l(  -I'. 


HUN    H       A    I'nid,'   i"   American    Medical    sui  RICHET.  C.     |'hy-i"lon 

;,.,;.-:,  H,  !-..]»•   .....  .    ..       I'''  Cerebral'  Cnnvniutin,,*  .......  '  ......       :;« 

INGALS.    E.    F.      !>:.  ,-i...-;-    ai,.l    Tivattn.  n!    nf  RINGER,  S.      Hand-bonk  nf  Therapeutics  ......    I'! 

|r.  ,a-,-    ..f    i!u     (';.,-•.     I  in-  .iit.     :in.l  ROBINSON.  B.     lln    Na-al  Catarrh  uml    Allied 
\a  ai  C.-iMt  .-..                                     .....    I'.'  I),  -,,,-,.-          ........................    IJl 

JACOBI.  A.     A  Tiviiti-'i'ii  iMphthcr!  i      ......   :;i  ROCKWELL.  A.  D.    [.crturcs  ,.u  KU-ctrifit.v  ^Dy- 

JAMES.  P.     l.arYiiL'o-n'i'y  mill  litiiM-enpy  ..    .   'M  nainie  and  Franklinic)  .........  '....'..     f, 

JOHNSON.  L.      \  Medi.  al  r,.r:.  .:...ir.    .........    |:;  ROOSA,  D.  B.  ST.  J.     <  >„  ihe  Diseasi'suf  the  Ear  33 

\    M.  •.;•..  -a!    P..  .till:-.  ...........     ''•  -    Ve-t-I'ncket    Medical     I..\ie..n     ..........       !» 

JOHNSON   and    MARTIN.     The  Inthience  of  —  Ophthalmic  and  Otic  Memoranda.  ..   HI 

Tinpicai  <  lituaii-   nn  K-.r.'p.  aii  t'.m<t  i  ROSENTHAL.  M.    nnihe  I  >i-ea.-es  of  the  Ner- 

.......     .pi  von-  S\  -ten,  .....................       .'!."> 

KEETLEY.  C.  B.      '  .   -'    Stif-.-r  ......   •-'•.'  ROSS,  J.     A  Treati-e  on  the  I  lisraM'S  of  the  Ner- 

KELSEV.  C.   B.     P.  -,.i-.-    of  ••.••    i;.-.-min    and  vmi-  sy-teni  .......................   :>,! 

\,;,^  ..................    !•-'  ROUTH,  C.  H.  F.        Infant  1-Yi-ilinn  audits  In- 

KEYES.  E.  L.      \VntT.-al  I>S.-a«.^     .........    -tl  tlr.,-n.-.-  .  n    I.:fo    ...................    :;0 

KIRBY    F.  O.    \  Tivuti-.-i'ii  Vi-ii'v!i:ary  Mrilirini'  -Hi  SALTER.    H.    H.     <  in    Astlnna  :    It-    I'athol.iu'y 
KIRKE'S  HANDBOOK  OF   PHYSIOLOGY.  ].S  mid  Tivalini'til  ..................       '    ".}'.} 

KLOB.  J.  M       I'.i;!,..:.      •  tin-    1'.-  SALTER.  J.  A.      Di-nial  I'utholojry  uml  Sur^-ry.  'i-1 

...".  ...........   <>:  SATTERTHWAITE.  T.  E.     A  JIaiiiuil  uf  )[fs- 

K  N  A  p  p.  H.    .      :  ..........  :;i  !.,;..._•>  .............................     r.i 

LAMBERT.  T.  S.      I'riu    •:      Sy-:.-!:.ati.-  Ilnntan  SAVAGE.  H.     Th.-  Snr-ical  Patliolnuv  ........    8S 

i"  .--...-•..    \;..,:..v     .'  .,i  .ill-.-;,  tic   .  .  .    IN  SEE,  G.      !>:  -,•.-!-,  -  nf  tin-  I.  uni:s  ...............    .•;:] 

LE\VIN.  L  '    '1  In'  I:       I.  'iiia     Ktl      :     "i   Drills         -15  SEGUIN,   E.      |.lini-\   ami   its  'rrratiiiriii    l.v  iln. 
LID.-LL.  J.  A.      Ap..pl.'\y       ........  '  .....   ::'i  I'liy.-iulM-ic'al  .Mctlioil  ........    ...'.....'i7 

LIVEING.  R.     HII  pl'r.-ari!i.'in  nf  skin  Disi-usi-s.   -I!  -          -  MnliiMl  TiiiTiiitiiiH-to-  uml    Iliiiuan  T.'in- 

.......   -I!  pi-i-iitiiri-     .......  ".  ..............         7 

LONGSTRETH.    M.     l:h.-imiai   -in.   C.ut.  and  SEMELEDER,   F.      IMiinnscnpy  and    I.arynirn- 

' 


LOOMIS.  A    L.      I  ..-:..,.:,!,.,.-       .      .      ..II  SIMS.  J.   M.     (  In  Uterine  Sur<j.T.v  ..........       -^i 

f    -;:.     II.  .-pirat'.ry    ()ivan>,  SKENE.   A.   J.    C.      I  >i.-..a.-e.-  nf  i  he  Illaddrr  and 
li      i-r,  and  !\i  i      y  ...............    1I  I'  P.;  lira  in  Wonit-n  ................    SC. 

-      \  T.     •  "  ......     II  SMITH.    E.      (in   Di-.  a-c  in  ChildnMi  ...........    '.''.I 

I...-   n    n  l-i     -.*•<''  I'lrj:,.,-:-  .....    n;  STEEL.  J.  H.     i  iiitlim-s  of  Kiinim-  Anntoiin    ..    -ID 

LYMAN.    H.     M.        Art;]      ;ii    Ai.a-tli.-.-ia    and  STELLWAG.   C.       On    tin-    K\e,    in.-liaiin-'  t  ti- 

......  I  \iialniiis   ..f  the  i  M-u'an    .  ...    31 

MACKENZIE.    M.      I  >-,-,,-,•-   ,,;    i  h.  -I'liavMix,  STERNBERG.  G.  M.  and  MAGNIN.  A.     I!a.'- 

i.  .•          .  !.•>.,  a  .  .  .    :j.|  i,  i-j;i  .......  ...}0 

MILTON.    J.    L.      i-  nd    Tn-at  nil-ill    ..f  STERNBERG.    G.    M.      Malaria     and     Malarial 

'•..I...M  ......    :;-~  hi-ca-i  -  ......................       Hi 

M::.LAHU,  H.  B.  i'  ~.-.a-,.  ..f  iu,.  STEWART.  T.  G.    im  p,r;-iir-  uisca-o  ..f  n,.' 

.......  .............  :;'.i  Kidney*   ............................    i'1 

MuK.'AN.  f:    E.     i;  •    •:-,  T:  •  .  .,     .•-..,,.,  i  T!,,  M,  STRICKER.   S.      A  Manual  nf  Hi-tnlniry  .......    2n 

.'  ........     f,  STURGIS.  F.  R.     Mi'di.-nl  Tnpi,^  ........         n; 

MTTNDE.  P    F.      •'         •  ,    HM,  ,.,•,,  i,,Lry  .        -jr,  TAIT,   L.      Disesi-e-  of  Wom-n  .  .  .  . 

M';Ki.'HISON.  C.    M,,]'  ,      irralip-n'ifnt-  -  (  Hi  Di-.'a-i-  (.f  the  O\anc-  .............    -J- 

>  TAYLOR.   C.   F.      Merhi»ni«MlTiviitmcnt  of  ])is. 

<•»  ------  f  ill.-  Ifip-J.iinl       ............    -'I 

THUDICHUM,  J.   L    W.     A  Manual  of  Clif-m- 


.  ;:>.  E  •  •,..  e .    P;  TIDY.  c.  M.    i..  L 

!IDJE.  E.  L.          •'    •         nf  <  M,M,  trie*        •  •:,  TILT.  E.  J.      \  Ma 

i!,..,  in  •  ..  ...  •.'- 

•J-.'  TROUSSEAU.   A.      Treatise  on  Therapeutic-  .      II 

PEABOhY.      ;      I.  :     i,    Xiem^.-nS  VERRIER.   E.      Practical  Manual  nf  <  Ih-tetri.- .   -J7 

1"  VIDAL.   A.     in,   Vcncrial  Hi- a--   11 

THAR:.:  :         •  r    IHE      UNITED  VISITING  LIST .  ...     in 

I-J  VON    TROELTSCHE.   A.      l)i-ea f  the  Kar 

li  WAGNER.    E.      A   Manual  nf  Cenera     PathnlnK>       1 

WEISSE.    T.   D.     The  Detnnn-ir.itnv 1 

II  WENDT.   E.   C.      ATreali-enn    \-iatic  Cholera.    i:> 

iURFS    FI    H    PHYSICIANS'    OFFICES  WEST.   C.      II. ,«   m  Nurse  r-iek  Children  '.'It 

',:.  WILSON.   E.     The  Sn 

1  M.  dieiiie  nn.i   |ii-i'  iv-  .at] 


•J  I                           ln.irj_Mi,ii.  and  i  Iriranie I.") 

I    d;eal  Stn.lenl.-'  Mannal  ..f  <   hem.-tiy  -i:. 

.  UEX   RERUM ."' 

yii      WYETH.    J.    A.       \    llnndl !.    nf    Me.'deal    and 

in  Sur  rieal   \nai..inv  and  Surtri  r\  .  --':; 
1      ZILMSSEN.     H.     VON.       Cyelo|p!i..li.i     of     th.' 

f  Medicine  1" 

!''.     ZIEGLER.   E.       \   ri'\tli.i.,k  ..f  PalhnlnKJcal  An- 
il                                      and    Pa,tli"--.'en.--i.-.  .  .                       .  ! 


OF  CALIFORNIA    \T    LOS   ANGELES 


